Humoral immune response to inactivated COVID-19 vaccination at the 3rd month among people living with HIV.

BACKGROUND: Research on the immune response to inactivated COVID-19 vaccination among people living with HIV (PLWH) is limited, especially among those with low CD4+ T lymphocyte (CD4 cell) count. This prospective cohort study aimed to assess the humoral immune response to inactivated COVID-19 vaccination among PLWH compared to HIV negative controls (HNCs) and to determine the impact of CD4 cell count on vaccine response among PLWH. METHODS: The neutralizing antibodies (nAbs) and the specific IgM and IgG-binding antibody responses to the inactivated COVID-19 vaccine at the third month after the second dose of inactivated COVID-19 vaccination were measured among 138 PLWH and 35 HNCs. Multivariable logistic regression and multiple linear regression models were conducted to identify factors associated with the seroconversion rate of antibodies and the magnitude of anti-SARS-CoV-2 antibody titers, respectively. RESULTS: At the end of the third month after two doses of vaccination, the seroconversion rates of IgG were comparable between PLWH (44.9%; 95% CI 36.5-53.3%) and HNCs (60.0%; 95% CI 42.9-77.1%), respectively. The median titers and seroconversion rate of nAbs among PLWH were 0.57 (IQR: 0.30-1.11) log10 BAU/mL and 29.0% (95% CI 21.3-36.8%), respectively, both lower than those in HNCs (P < 0.05). After adjusting for age, sex, comorbidities, and CD4 cell count, the titers and seroconversion rate of nAbs were comparable between PLWH and HNCs (P > 0.05). Multivariable regression analyses showed that CD4 cell count < 200/µL was independently associated with lower titers and seroconversion rate of nAbs among PLWH (P < 0.05). A positive correlation was observed between the CD4 cell count and nAbs titers in PLWH (Spearman's ρ = 0.25, P = 0.0034). CONCLUSION: Our study concluded that the immune response to inactivated COVID-19 vaccination among PLWH was independently associated with CD4 cell count, PLWH with lower CD4 cell count showed a weaker humoral immune response, especially those with CD4 cell count < 200/µL. This finding suggests that expanding COVID-19 vaccination coverage among PLWH is impendency. In addition, aggressive ART should be carried out for PLWH, especially for those with low CD4 cell count, to improve the immune response to vaccines.

Six-month humoral immune response to inactivated COVID-19 vaccine among people living with HIV.

Longitudinal humoral immune response to inactivated COVID-19 vaccines among people living with HIV (PLWH) have not yet been systematically investigated. We conducted a 6-month longitudinal study among vaccinated PLWH and HIV-Negative Controls (HNC) to determine whether the humoral immune response effects of the inactivated COVID-19 vaccine are different between the two groups of people. Totally, 46 PLWH and 38 HNC who received the inactivated COVID-19 vaccine on days 0 and 28 were enrolled. The SARS-CoV-2 neutralizing antibodies (nAbs) and total specific IgM and IgG antibodies were examined on Day 0-Day190. The level and positive seroconversion rate of nAbs peaked on Day 42 in HNC while peaked on Day 70 in PLWH, then decreased gradually with the extension of the vaccination period after the peaks. The peak level of nAbs in PLWH on Day 70, (GMC 8.07 BAU/mL, 95% CI 5.67-11.48) was significantly lower than in HNC on Day 42 (GMC 18.28 BAU/mL, 95% CI 10.33-32.33, P =0.03). The decrease in the geometric mean concentrations (GMCs) of nAbs was observed as 42.9% in PLWH after peak level, which decreased from 8.07 BAU/mL [95% CI: 5.67-11.48] on Day 70 to 4.61 BAU/mL [95% CI: 3.35-6.34] on Day 190 (p = 0.02). On Day 190, only seven (18%, [95% CI: 6-40]) HNC and five (11%, [95% CI: 4-25]) PLWH maintained positive nAbs response respectively. The geometric mean ELISA units (GMEUs) and positive seroconversion rate of IgG in PLWH dropped significantly from Day 70 (GMEUs, 0.20 EU/mL, [95% CI: 0.13-0.34]; seroconversion, 52%, [95% CI: 34-69]) to Day 190 (GMEUs, 0.05 EU/mL, [95% CI: 0.03-0.08], P<0.001; seroconversion, 18%, [95% CI: 8-33], P<0.001). There was no significant difference in levels and seroconversion rates of nAbs and IgG between the two groups on Day 190. The peak immunogenicity of the inactivated COVID-19 vaccine was delayed and inferior in PLWH compared to HNC, while no significant difference was found in six-month immunogenicity between the two groups.

Six-month humoral immune response to inactivated COVID-19 vaccine among people living with HIV

Longitudinal humoral immune response to inactivated COVID-19 vaccines among people living with HIV (PLWH) have not yet been systematically investigated. We conducted a 6-month longitudinal study among vaccinated PLWH and HIV-Negative Controls (HNC) to determine whether the humoral immune response effects of the inactivated COVID-19 vaccine are different between the two groups of people. Totally, 46 PLWH and 38 HNC who received the inactivated COVID-19 vaccine on days 0 and 28 were enrolled. The SARS-CoV-2 neutralizing antibodies (nAbs) and total specific IgM and IgG antibodies were examined on Day 0-Day190. The level and positive seroconversion rate of nAbs peaked on Day 42 in HNC while peaked on Day 70 in PLWH, then decreased gradually with the extension of the vaccination period after the peaks. The peak level of nAbs in PLWH on Day 70, (GMC 8.07 BAU/mL, 95% CI 5.67-11.48) was significantly lower than in HNC on Day 42 (GMC 18.28 BAU/mL, 95% CI 10.33-32.33, P =0.03). The decrease in the geometric mean concentrations (GMCs) of nAbs was observed as 42.9% in PLWH after peak level, which decreased from 8.07 BAU/mL [95% CI: 5.67-11.48] on Day 70 to 4.61 BAU/mL [95% CI: 3.35-6.34] on Day 190 (p = 0.02). On Day 190, only seven (18%, [95% CI: 6-40]) HNC and five (11%, [95% CI: 4-25]) PLWH maintained positive nAbs response respectively. The geometric mean ELISA units (GMEUs) and positive seroconversion rate of IgG in PLWH dropped significantly from Day 70 (GMEUs, 0.20 EU/mL, [95% CI: 0.13-0.34];seroconversion, 52%, [95% CI: 34-69]) to Day 190 (GMEUs, 0.05 EU/mL, [95% CI: 0.03-0.08], P<0.001;seroconversion, 18%, [95% CI: 8-33], P<0.001). There was no significant difference in levels and seroconversion rates of nAbs and IgG between the two groups on Day 190. The peak immunogenicity of the inactivated COVID-19 vaccine was delayed and inferior in PLWH compared to HNC, while no significant difference was found in six-month immunogenicity between the two groups.

COVID-19 Vaccination Willingness Among People Living With HIV in Wuhan, China.

Vaccination is essential to controlling the pandemic of coronavirus disease 2019 (COVID-19). People living with HIV (PLWH) were considered more vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection compared with the general population. Therefore, it is urgent to protect PLWH from SARS-CoV-2 infection. For PLWH, vaccine hesitancy could be more common and may compromise vaccine coverage. Our study aimed to investigate the willingness to receive the COVID-19 vaccination among PLWH and associated factors. A cross-sectional online survey was performed among PLWH and the general population from 4 April to 18 April 2021 in Wuhan, China. The multivariable logistic regression was used to analyze associated factors for COVID-19 vaccination willingness among PLWH. A total of 556 PLWH and 570 individuals from the general population were enrolled. The COVID-19 vaccine willingness among PLWH was 60.8%, which was relatively lower than that in the general population (80.9%) (P < 0.001). The results of multivariable analysis indicated that PLWH with comorbidities (OR = 2.07, 95% CI: 1.25-3.45), those who had idea about PLWH would be more serious if they were infected with SARS-CoV-2 (OR = 1.67, 95% CI: 1.11-2.51) and those who thought their antiretroviral therapy (ART) would be affected by COVID-19 epidemic (OR = 2.04, 95% CI: 1.22-3.42) had higher willingness to receive COVID-19 vaccination. PLWH who had a monthly income over 5,000 RMB (OR = 0.64, 95% CI: 0.45-0.92) and had a sex orientation as non-homosexual (OR = 0.67, 95% CI: 0.47-0.96) were associated with lower willingness for COVID-19 vaccination. Our findings showed that the PLWH had a lower willingness for COVID-19 vaccination compared with the general population in Wuhan. Targeted interventions such as health education should be conducted to increase the willingness for COVID-19 vaccination among PLWH, thus enhancing COVID-19 vaccine uptake among PLWH.

Risk of SARS-CoV-2 Infection Among People Living With HIV in Wuhan, China.

Background: In the era of the COVID-19 pandemic, people living with HIV (PLWH) face more challenges. However, it is unclear if PLWH is more susceptible to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than HIV-negative individuals. This study aimed to explore the prevalence of the SARS-CoV-2 infection and the associated risk factors among PLWH. Methods: From 1 to 30 May 2020, we conducted a cross-sectional survey that enrolled 857 PLWH and 1,048 HIV-negative individuals from the Wuchang district in Wuhan, China. Our data analysis compared the rate of the SARS-CoV-2 infection among PLWH and HIV-negative participants, and the proportions of symptomatic patients and asymptomatic infectors between the two groups. We also assessed the risk factors associated with the SARS-CoV-2 infection among PLWH. Results: Overall, 14/857 (1.6%) PLWH and 68/1,048 (6.5%) HIV-negative participants were infected with SARS-CoV-2. Among the SARS-CoV-2-infected PLWH participants, 6/14 (42.8%) were symptomatic patients, 4/14 (28.6%) were SARS-CoV-2 nucleic acid-positive asymptomatic infectors, and 4/14 (28.6%) were serology-positive asymptomatic infectors. Among the infected HIV-negative participants, 5/68 (7.4%) patients were symptomatic and 63/68 (92.6%) were serology-positive asymptomatic infectors. The rate of the SARS-CoV-2 infection was lower among the PLWH than in the HIV-negative group (1.96% vs. 5.74%, p = 0.001) and the rate of morbidity among the symptomatic patients was similar between the two groups (p = 0.107). However, there were more serology-positive asymptomatic infectors among the infected HIV-negative participants than among the infected PLWH (0.54% vs. 5.46%, p = 0.001). Furthermore, being 50 years or older (aOR = 4.50, 95% CI: 1.34-15.13, p = 0.015) and having opportunistic infections (aOR = 9.59, 95% CI: 1.54-59.92, p = 0.016) were associated with an increased risk of SARS-CoV-2 infection among PLWH. Conclusions: PLWH has more varied forms of the SARS-CoV-2 infection than the HIV-negative population and should, therefore, undertake routine screening to avoid late diagnosis. Also, older age (≥50 years) and having opportunistic infections increase the risks of SARS-CoV-2 infection among PLWH.

Driving force of COVID-19 among people living with HIV in Wuhan, China.

BACKGROUND: Although people living with HIV (PLWH) were considered to be at increased risk of SARS-CoV-2 infection, the driving force among this group of individuals is still not clear. METHODS: We investigated 1,709 PLWH through a telephone interview and identified 11 COVID-19 patients in four districts of Wuhan, China. The demographic features and major clinical characteristics of these patients were retrieved from the information management systems for COVID-19 patients of the four districts' CDC. Statistical analysis was performed to find out the driving force of COVID-19 among PLWH. RESULTS: The prevalence of COVID-19 in PLWH is 0.6% (95% CI: 0.2% - 1.0%), which is comparable to the overall population prevalence in Wuhan city (0.6%). Nine out of the 11 COVID-19 patients had relatively high CD4+ T lymphocyte count (>200/µl) and undetectable HIV viral load (<20 copies/ml), and ten of them were on antiretroviral therapy. Older PLWH with low CD4 + count, got HIV infected through homosexual activity, and had been diagnosed with HIV for a long time, were more likely to develop COVID-19. CONCLUSIONS: COVID-19 related morbidity rates were comparable between PLWH and the general population. Older age with low CD4 count, an extended period of HIV diagnosis, and treatment-naivety were potential driving forces of COVID-19 prevalence among PLWH. Strategies for preventing SARS-CoV-2 infection among PLWH with weak immune responses are required.

Adverse events of inactivated COVID-19 vaccine in HIV-infected adults.

This study aims to evaluate the safety of inactivated COVID-19 vaccine among adult people living with HIV (PLWH). In total, 259 PLWH who received at least one dose of inactivated COVID-19 vaccine were enrolled, and post-vaccination adverse events (AEs) were evaluated seven days following each vaccination dose. The overall AE frequency was 22.8% after dose one, which was higher than after dose two (10.2%) (P < 0.001). No severe side event or vaccine safety concern was observed. Our finding was essential in reducing vaccine hesitancy among PLWH.

People living with HIV easily lose their immune response to SARS-CoV-2: result from a cohort of COVID-19 cases in Wuhan, China.

BACKGROUND: To date, whether the immune response for SARS-CoV-2 infection among people living with HIV(PLWH) is different from HIV-naïve individuals is still not clear. METHODS: In this cohort study, COVID-19 patients admitted to hospitals in Wuhan between January 15 and April 1, 2020, were enrolled. Patients were categorized into PLWH and HIV-naïve group. All patients were followed up regularly (every 15 days) until November 30, 2020, and the immune response towards SARS-CoV-2 was observed. RESULTS: Totally, 18 PLWH and 185 HIV-naïve individuals with COVID-19 were enrolled. The positive conversion rates of IgG were 56% in PLWH and 88% in HIV-naïve patients respectively, and the peak was on the 45th day after COVID-19 onset. However, the positive rate of IgG dropped to 12% in PLWH and 33% among HIV-naïve individuals by the end of the study. The positive conversion rate of IgG among asymptomatic carriers is significantly lower than that among patients with moderate disease (AOR = 0.24, 95% CI 0.07-0.85). PLWH had a lower IgG seroconversion rate (AOR = 0.11, 95% CI 0.03-0.39) and shorter IgG duration (AHR = 3.99, 95% CI 1.43-11.13) compared to HIV-naïve individuals. Patients with higher lymphocyte counts at onset had a lower positive conversion rate (AOR = 0.30, 95% CI 0.10-0.87) and shorter duration for IgG (AHR = 4.01, 95% CI 1.78-9.02). CONCLUSIONS: The positive conversion rate of IgG for SARS-CoV-2 was relatively lower and quickly lost in PLWH.

Distinct Infection Forms of SARS-CoV-2 Among People Living With HIV.

BACKGROUND: People living with HIV (PLWH) are immunodeficient, it is vague if they are more susceptible to SARS-CoV-2 infection than HIV negative individuals. METHODS: In this cross-sectional study, 857 PLWH and 1048 HIV negative individuals were enrolled from the Wuchang district in Wuhan, China. We compared the total rate of SARS-CoV-2 infection, the rate of COVID-19, asymptomatic carriers, and unapparent infectors in the two groups. The risk factors associated with SARS-CoV-2 infection among PLWH were explored. RESULTS: Fourteen out of 857 (1.63%) PLWH were infected with SARS-CoV-2, while 68 of 1048 (6.49%) HIV negative individuals were infected. In PLWH, there were 6 confirmed COVID-19 (0.70%), 4 asymptomatic carriers (0.47%) and 4 unapparent infectors (0.47%). In the HIV negative group, the cases of COVID-19, asymptomatic carrier, and unapparent infector were 5 (0.48%), 0 (0.00%), and 63 (6.01%), respectively. After adjusting for age, gender, and chronic comorbidities, the rate of SARS-CoV-2 infection in PLWH was lower than that in HIV negative group (1.96% vs 5.74%, P=0.001). The morbidity of COVID-19 was similar between the two groups (P=0.107), but the rate of unapparent infection in PLWH was lower than that in the HIV negative group (0.54% vs 5.46%, P=0.001). Older age (aOR=4.50, 95%CI: 1.34-15.13, P=0.015) and OIs (aOR=9.59, 95%CI: 1.54-59.92, P=0.016) were risk factors for SARS-CoV-2 infection among PLWH. CONCLUSIONS: PLWH has different infection forms of SARS-CoV-2 compared with the general population. Older age and OIs were considered to driving causes of SARS-CoV-2 infection among PLWH.

People Living with HIV Easily lose their Immune Response to SARS-CoV-2: Result From A Cohort of COVID-19 Cases in Wuhan, China.

Background To date, whether the immune response for SARS-CoV-2 infection among people living with HIV(PLWH) is different from HIV-naïve individuals is still not clear. Methods In this cohort study, COVID-19 patients admitted to hospital in Wuhan between January 15 and April 1, 2020, were enrolled. Patients were categorized into PLWH and HIV-naïve group. All patients were followed up regularly (every fifteen days) until November 30, 2020, and the immune response towards SARS-CoV-2 was observed. Results Totally, 18 PLWH and 185 HIV-naïve individuals with COVID-19 were enrolled. The positive conversion rates of IgG were 56% in PLWH and 88% in HIV-naïve patients respectively, and the peak was on the 45th day after COVID-19 onset. However, the positive rate of IgG dropped to 12% in PLWH and 33% among HIV-naïve individuals by the end of the study. The positive conversion rate of IgG among asymptomatic carriers is significantly lower than that among moderate patients (AOR = 0.18, 95% CI: 0.05-0.65) and PLWH had a lower IgG seroconversion rate compared to the HIV-naive group (AOR = 0.22, 95% CI: 0.05-0.90). Patients with lower lymphocyte counts at onset had a higher positive conversion rate (AOR = 0.29, 95% CI: 0.09-0.90) and longer duration for IgG (AHR = 4.01, 95% CI: 1.78-9.02). Conclusions The positive conversion rate of IgG for SARS-CoV-2 was relatively lower and quickly lost in PLWH, which meant PLWH was in a disadvantaged situation when affected with COVID-19.

The Diagnostic Trap Occurred in Two COVID-19 Cases Combined Pneumocystis Pneumonia in Patient with AIDS.

Background : The limited knowledge on the diagnosis of Coronavirus disease 2019 (COVID-19) at the early stage of the pandemic may lead to misdiagnoses, especially when the nucleic acid inspection cannot meet the mass requirement. This condition is even actual for people who are living with HIV/AIDS (PLWHA), for the latter is vulnerable to variable infections. Case Presentation : In this short communication, we introduced two HIV infected individuals who had PCP but was misdiagnosed as COVID-19 initially, and finally infected with SARS-CoV-2 in hospital in Wuhan, China. Eventually, both patients improved soon after they were switched to the treatment of SMZ/TMP. Conclusions : We suggested that the hospitalized COVID-19 cases should be screened with HIV and other pathogens, to prevent that PLWHA who have PCP from being misdiagnosed as COVID-19.

Driving Force of Covid-19 Among People Living With HIV/AIDS in Wuhan, China.

Background: Even people living with HIV/AIDS (PLWHA) were considered to be at increased risk of SARS-CoV-2 infection, the driving force among this group of individuals is still not clear. Methods : We investigated 1,701 PLWHA through a telephone interview and found 11 COVID-19 patients in four districts of Wuhan, China. The demographic features and major clinical characteristics of these patients were retrieved from the information management systems for COVID-19 patients of four districts' CDC. Statistical analysis was performed to find out the driving force of COVID-19 among PLWHA. Results : The incidence proportion of COVID-19 in PLWHA is 0.6% (95% CI: 0.2% - 1.0%), which is comparable to the overall population incidence rate in Wuhan city (0.6%). Nine out of the 11 COVID-19/AIDS patients had relatively high CD4+ T lymphocyte count (>200/µl) and undetectable HIV viral load (＜20 copies/ml), and ten of them were on antiretroviral therapy. PLWHA who were old, had low CD4+ T lymphocyte count, infected HIV through homosexual activity, and had been diagnosed for HIV for a long time, were more likely to develop COVID-19. Conclusions: PLWHA has comparable COVID-19 morbidity rates as the general population, and older age, low CD4 count, long length since HIV diagnosis, and treatment-naive were potential driving forces of COVID-19 occurrence among PLWHA. Strategies in preventing SARS-CoV-2 infection among PLWHA with worse immune responses are needed. Article Summary Line: As COVID-19 continues to spread around the world, people living with HIV/AIDS (PLWHA) are also at risk of infection with SARS-CoV-2. We investigated the factors associated with SARS-CoV-2 infection among PLWHA in Wuhan, China.