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1.
Open Forum Infectious Diseases ; 8(SUPPL 1):S805, 2021.
Article in English | EMBASE | ID: covidwho-1746280

ABSTRACT

Background. Limited data are available on whether there are differences in the immune response to SARS-CoV-2 vaccination by HIV status or by mRNA vaccine type. Methods. We saved residual outpatient laboratory samples of all previously mRNA-vaccinated individuals in the adult medicine clinics of a public hospital with a large outpatient HIV clinic during May 2021, and then excluded individuals with prior SARS-CoV-2 infection. We next 1:1 matched 100 PLWH to 100 outpatient HIVnegative adult medicine patients receiving care for chronic medical conditions on days since completion of second vaccination (minimum 10), sex, age +/-5 years, and the type of mRNA vaccine received. We defined a non-response as reciprocal pseudovirus neutralizing titer< 10 and anti-RBD IgG< 10 relative fluorescent units, and compared non-response by HIV status using mixed models. Results. In each matched group there were 13 women;25 received the mRNA-1273 vaccine and 75 received the BNT162b2 vaccine;the median age was 59. The median time from second vaccination was 35 days (IQR: 20-63). Among PLWH, the median CD4+ T-cell count was 511 (IQR: 351-796) and 5 individuals had HIV RNA > 200. We found 2.4-fold greater odds of pseudovirus neutralizing antibody non-response among PLWH compared to people without HIV (95% CI=1.1-5.4). Although few individuals in each group did not mount an IgG response (12 among PLWH vs. 5;p=0.08), continuous anti-RBD IgG concentrations were 43% lower among PLWH (95% CI=0.36-0.88). Among PLWH, when adjusting for age, sex, and days post-vaccination, each 100-cell increase in CD4+T-cell count was associated with 22% higher neutralizing antibody titers (GMR 1.22;95% CI=1.09-1.37). Unsuppressed HIV RNA >200 was associated with 89% lower neutralizing antibody titers (GMR 0.11;95% CI=0.01-0.84). Receipt of the BNT162b2 vs. mRNA-1273 vaccine was associated with 77% lower neutralizing titers (GMR 0.23;95% CI=0.08-0.65) among PLWH. Post-mRNA Vaccination SARS-CoV-2 IgG Concentrations and Pseudovirus Neutralizing Titers by HIV Status and Vaccine Conclusion. PLWH had lower than expected response to mRNA SARS-CoV-2 vaccines, with the highest non-response among those with low CD4+ counts, unsuppressed HIV RNA, and those who received the BNT162b2 vaccine. Immunization strategies to improve immune responses among PLWH should be studied, and may include booster vaccination or preference of the mRNA-1273 vaccine in this group.

2.
American Journal of Clinical Pathology ; 156:S32-S32, 2021.
Article in English | Web of Science | ID: covidwho-1532435
3.
Annals of Oncology ; 32:S1137-S1138, 2021.
Article in English | EMBASE | ID: covidwho-1432865

ABSTRACT

Background: We assessed mortality risk by COVID-19 (C19) infection among treated cancer patients (pts) and the impact of anti-cancer treatment (tx) on mortality. Methods: Optum de-identified Electronic Health Record dataset (2021-01-07 release) were used to find cancer pts with a C19 positive (ICD-9/10-CM codes U071/U072 or positive test result) or negative (negative test and no positive test at any time after the first negative result) status on the first test/diagnosis date (ie the “index date”). Pts with <1 year database history, with no tx 0-90 days before index, <18 years old, with implausible death dates, and with index dates outside of 02/2020 - 11/2020 were excluded. C19 positive and negative pts were exact-matched on cancer type, then 1:1 nearest-neighbor matched on propensity scores (variables in table). Missing values were imputed (n = 5), and outcomes were evaluated by multivariable logistic regression, including interaction terms between tx and C19 positivity. Results: We identified 21,060 pts, of whom 1,636 (7.8%) were positive for C19 and 19,424 (92.2%) negative. Among 1,636 matched pairs of positive/negative C19 pts, the odds ratio (OR) of 30-day mortality comparing C19 positive vs negative patients was 2.14 (95% CI: 0.71 – 6.52). Among the strongest predictors of 30-day mortality were age 75+ (OR = 5.42, 95% CI: 2.21 – 13.28), inpatient C19 testing/diagnosis (OR = 4.78, 95% CI: 3.04, 7.53), CCI of 3+ (OR = 2.24, 95% CI: 1.30 – 3.89), and metastatic disease (OR = 1.80, 95% CI 1.21 – 2.68). Anti-cancer therapies do not appear to modulate risk of death due to C19. Beyond 30-day mortality, matched mortality rate ratios (MRRs) suggested increased risk for C19 positive patients (MRR = 1.85, 95% CI: 1.26 – 2.44). [Formula presented] Conclusions: C19 showed a trend towards increased 30-day mortality risk (not statistically significant), and increased overall mortality risk. Specific tx did not appear to modulate 30-day mortality due to C19. Legal entity responsible for the study: Genentech, Inc. Funding: Roche/Genentech. Disclosure: P.A. Ascierto: Financial Interests, Personal, Advisory Board: Bristol Myers Squibb, Roche-Genentech, Merck Sharp & Dohme, Novartis, Array, Merck Serono, Pierre-Fabre, Incyte, Medimmune, AstraZeneca, Syndax, Sun Pharma, Sanofi, Idera, Ultimovacs, Sandoz, Immunocore, 4SC, Alkermes, Italfarmaco, Nektar, Boehringer Ingelheim;Financial Interests, Personal, Research Grant: Bristol Myers Squibb, Roche-Genentech, Array, Sanofi;Financial Interests, Personal, Other: MSD;Non-Financial Interests, Personal, Advisory Board: TAKIS. M.H. Secrest: Financial Interests, Personal, Full or part-time Employment: Roche/Genentech;Financial Interests, Personal, Stocks/Shares: Roche. P. Lambert: Financial Interests, Personal, Full or part-time Employment: Genentech/Roche;Financial Interests, Personal, Stocks/Shares: Roche. K. Sarsour: Financial Interests, Personal, Full or part-time Employment: Roche/Genentech;Financial Interests, Personal, Stocks/Shares: Roche. A. Tan: Financial Interests, Personal, Full or part-time Employment: Roche/Genentech;Financial Interests, Personal, Stocks/Shares: Roche. R. Walls: Financial Interests, Personal, Full or part-time Employment: Hoffmann-La Roche;Financial Interests, Personal, Stocks/Shares: Hoffmann-La Roche. J. Reddy: Financial Interests, Personal, Full or part-time Employment: Roche/Genentech;Financial Interests, Personal, Stocks/Shares: Roche. A. Seetasith: Financial Interests, Personal, Full or part-time Employment: Genentech, Inc.;Financial Interests, Personal, Stocks/Shares: Roche. D. Shenison: Financial Interests, Personal, Full or part-time Employment: Roche/Genentech;Financial Interests, Personal, Stocks/Shares: Roche, Cigna. I. Ngwa: Financial Interests, Personal, Full or part-time Employment: F. Hoffmann - La Roche Ltd;Financial Interests, Personal, Stocks/Shares: F. Hoffmann - La Roche Ltd. C. Yun: Financial Interests, Personal, Full or part-time Employment: Genentech, Inc.;Financial Interests, Personal, Stocks/Shares: Roche. Q. Zhang: Financial Interests, Personal, Full or part-time Employment: Roche/Genentech;Financial Interests, Personal, Stocks/Shares: Roche, Regeneron, BMS, AbbVie, AC Immune.

4.
Topics in Antiviral Medicine ; 29(1):242, 2021.
Article in English | EMBASE | ID: covidwho-1250732

ABSTRACT

Background: Although data are mixed, most cohorts show a similar or lower COVID-19 incidence among people living with HIV (PLWH) compared to the general population. However, incidence may be impacted by lower testing rates among vulnerable populations. We compared SARS-CoV-2 seroprevalence and IgG levels, and disease severity, among patients with and without HIV receiving care within a county hospital system over a three-month period. Methods: From August through October 2020, remnant serum samples were collected from all PLWH who underwent routine outpatient laboratory testing at San Francisco General Hospital which houses a large HIV clinic (Ward 86). Patients with HIV were matched on time of collection (same day) and age (+/- 5 years) to 1-2 adults without HIV. SARS-CoV-2 levels of IgG levels was quantified in serum using the Pylon IgG assay (100% specificity on internal validation). Seroprevalence was compared by HIV status via conditional logit models, adjusting for sex. For those with reactive results, IgG levels were compared by HIV status using log-transformed generalized estimating equations. Severe disease, assessed via chart review, was defined as requiring oxygen. Results: Among 1,411 individuals (46% PLWH), the median age was 58 (IQR: 49-65), 64% were men. COVID-19 seroprevalence was 3.1% among PLWH compared to 6.8% among people without HIV (adjusted odds ratio 0.41;95% confidence interval (CI): 0.25-0.68, p<0.001). Among those with reactive COVID-19 IgG results (n=72, 20 in PLWH);antibody levels were 47% lower among PLWH (95% CI: 19-65% lower;p=0.003;Figure);however, there was a trend towards higher disease severity among PLWH [15% (n=3) vs. 4% (n=2);p=0.13]. Conclusion: Both seroprevalence, and absolute SARS-CoV-2 IgG levels in those with reactive results, were lower among PLWH, within a time and agematched population of outpatients receiving routine laboratory testing in an urban hospital. PLWH may have had higher adherence to non-pharmaceutical interventions (NPIs) than those without HIV, leading to lower COVID-19 seroprevalence and, possibly, lower COVID-19 IgG levels if infected with a lower viral inoculum due to NPIs. Alternatively, PLWH may mount lower antibody responses to SARS-CoV-2, as has been demonstrated with hepatitis B and yellow fever vaccines. Further studies of COVID-19 susceptibility and immunity are needed among PLWH. Moreover, PLWH should be enrolled in SARS-CoV-2 vaccine studies or followed after vaccination to ensure they mount sufficient humoral responses.

5.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-7510

ABSTRACT

Serosurveillance provides a unique opportunity to quantify the proportion of the population that has been exposed to pathogens. Here, we developed and piloted Serosurveillance for Continuous, ActionabLe Epidemiologic Intelligence of Transmission (SCALE-IT), a platform through which we systematically tested remnant samples from routine blood draws in two major hospital networks in San Francisco for SARS-CoV-2 antibodies during the early months of the pandemic. Importantly, SCALE-IT allows for algorithmic sample selection and rich data on covariates by leveraging electronic medical record data. We estimated overall seroprevalence at 4.2%, corresponding to a case ascertainment rate of only 4.9%, and identified important heterogeneities by neighborhood, homelessness status, and race/ethnicity. Neighborhood seroprevalence estimates from SCALE-IT were comparable to local community-based surveys, while providing results encompassing the entire city that have been previously unavailable. Leveraging this hybrid serosurveillance approach has strong potential for application beyond this local context and for diseases other than SARS-CoV-2.

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