Anti-Spike Antibodies and Neutralising Antibody Activity in People Living with HIV Vaccinated with COVID-19 mRNA-1273 Vaccine: A Prospective Cohort Study (preprint)

Background: Vaccines against COVID-19 are a powerful tool to control the current SARS-CoV-2 pandemic. A thorough description of their immunogenicity among people living with HIV (PLWHIV) is necessary. We aimed to assess the immunogenicity of the mRNA-1273 vaccine among PLWHIV.Methods: In this prospective cohort, adult PLWHIV outpatients were enrolled during the Italian vaccination campaign. Enrolment was allowed irrespective of ongoing combination antiretroviral therapy (ART), plasma HIV viral load and CD4+ T cell count. A two-dose regimen of mRNA-1273, with administrations performed 28 days apart, was employed. The primary outcomes were anti-spike (anti-S) antibody titres and neutralising antibody activity, assessed 28 days after completing the vaccination schedule, compared with individuals not affected by HIV (referred as healthy-donors, HDs). Findings: CD4+ T cell count groups and anti-nucleocapside (anti-N) positive serology were the only variables associated with anti-spike (anti-S) antibody titres (expressed as U/mL) and neutralising antibody activity. Anti-S antibodies were higher in COVID-19-experienced PLWHIV (median 12500 U/mL IQR [5704-12500]) than in COVID-19-naïve PLWHIV (median 2437 U/mL IQR [1485-4526]) but did not differ from those observed in COVID-19-experienced HDs (median 1077 U/mL IQR [702-7551]). Neutralising antibody activity in sera was higher in COVID-19-experienced PLWHIV (median 10888 IQR [2478-14416]) compared to COVID-19-naïve PLWHIV (median 1192 IQR [742-2421]) but was comparable to those observed in COVID-19-experienced HDs (median 20959 U/mL IQR [10060-31857]). When stratified according to CD4+ T cell count (<350 cells/μL, 350-500 cells/μL, >500 cells/μL), anti-S antibody titres (median 2173 U/mL [IQR 897-4109], 5763 IU/mL [IQR 4801-12500], 2449 U/mL [IQR 1524-5704]) were not lower to those observed among HDs (median 1425 U/mL [IQR 599-6131]). In addition, neutralising antibody activity, stratified according to the CD4+ T cell count (median 1314 [IQR 606-2477], 3329 IU/mL [IQR 1905-10508], 1227 U/mL [IQR 761-3032]), was similar to those displayed by HDs (median 2112 U/mL [IQR 719-8889]).Interpretation: Inoculation with mRNA-1273 vaccine given 4 weeks apart produced adequate immune responses in PLWHIV, who are well controlled on ART, irrespective of CD4+ T cell count and equivalent to individuals without HIV infection, supporting vaccination in PLWHIV.Funding: This study was partially supported by Italian Ministry of Health Ricerca Corrente 2021 and Grant Ricerca Finalizzata GR 2018-12365699, by Intesa San Paolo COVID-19 emergency 2020 funds, and by Fondazione Cariplo (INNATE-CoV).Declaration of Interest: All other authors declare no competing interests.Ethical Approval: The study protocol (286_2021) was approved by the INMI “Lazzaro Spallanzani” Ethics Committee (Roma, Italy),

Clinical Characteristics of Healthcare Workers with SARS-CoV-2 Infection after Vaccination with BNT162b2 Vaccine (preprint)

Background: The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has hardly affected the entire world. Vaccines against COVID-19 appear as a tool able to curb out the mortality and to reduce the circulation of the virus. Little is known so far about the clinical characteristics of individuals who developed SARS-CoV-2 infection after having received the vaccination, as well as the temporal relationship between vaccine administration and symptoms onset.Methods: Retrospective cohort study among the healthcare workers (HCWs) of the Fondazione IRCCS Ospedale Maggiore Policlinico of Milano, vaccinated with the BNT162b2 vaccine who developed SARS-CoV-2 infection (documented through positive RT-PCR on NPSs). Results: Overall, we have identified 15 HCWs with SARS-CoV-2 infection after vaccination, 7 (46.7%) of them were male and the mean age was 38.4 years (SD 14). In 4 of them the presence of SARS-CoV-2 anti-nucleocapside (anti-N) antibodies was assessed before vaccination and resulted positive in 1 case. In all HCWs the presence of SARS-CoV-2 anti-spike (anti-S1) antibodies was assessed, in average 42.2 days after the completion of vaccination, with a mean value of 2,055 U/mL (SD 1,927.3). SARS-CoV-2 infection was ascertained in average 56.2 days after vaccination. The mean cycle threshold (Ct) of SARS-CoV-2 PCR was 26.4, the lineage was characterized in 9 HCWs. None of the HCWs reported a primary or secondary immunodeficiency. Regarding symptoms, they were reported only by 7 (46.7%) HCWs and appeared on average 55 days after the second dose of vaccination. Of those who reported symptoms, one (14.3%) had fever, 7 (100%) rhinitis/conjunctivitis, 4 (57.1%) taste and smell alterations, none had respiratory symptoms, 4 headache/arthralgia (57.1%) and 1 gastrointestinal symptoms (14.3%). All symptoms disappeared in a few days and no other unclassified symptoms were reported.Conclusions: Infections occurring after vaccination with BNT162b2 vaccine are mostly asymptomatic and are not associated with the serum titre of anti-S1 antibodies. We did not find a predominance of a specific viral variants, with several lineages represented. 

Inflammatory biomarkers in pregnant women with COVID-19: a retrospective cohort study (preprint)

Coronavirus disease 2019 is a pandemic viral disease affecting also obstetric patients and uncertainties exist about the prognostic role of inflammatory biomarkers and hemocytometry values in patients with this infection. To clarify that, we assessed the values of several inflammatory biomarkers and hemocytometry variables in a cohort of obstetric patients hospitalized with coronavirus disease 2019 and we correlated the values at admission with the need of oxygen supplementation during the hospitalization. Overall, among 27 (61%) pregnant women and 17 (39%) post-partum women, 6 (14%) patients received oxygen supplementation and 2 (4%) required admission to intensive care unit but none died. During hospitalization neutrophils (p=0.002), neutrophils to lymphocytes ratio (p=0.037) and C reactive protein (p<0.001) decreased significantly, whereas lymphocytes (p<0.001) and platelets (p<0.001) increased. Leukocytes and lymphocytes values at admission were correlated with oxygen need, with respectively a 1% and 5% higher risk of oxygen supplementation for each 1,000 cells decrease. Overall, in obstetric patients hospitalized with coronavirus disease 2019, C reactive protein is the inflammatory biomarker that better mirrors the course of the disease whereas D-dimer or ferritin are not reliable predictors of poor outcome. Care to the need of oxygen supplementation should be reserved to patients with reduced leukocytes or lymphocytes values at admission.