Immunogenicity, effectiveness, and safety of SARS-CoV-2 vaccination in people with HIV.

Autor:	Griffin DWJ; Department of Infectious Diseases, Alfred Health.; Central Clinical School, Monash University, Melbourne, Victoria, Australia., Pai Mangalore R; Department of Infectious Diseases, Alfred Health.; Central Clinical School, Monash University, Melbourne, Victoria, Australia., Hoy JF; Department of Infectious Diseases, Alfred Health.; Central Clinical School, Monash University, Melbourne, Victoria, Australia., McMahon JH; Department of Infectious Diseases, Alfred Health.; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	AIDS (London, England) [AIDS] 2023 Jul 15; Vol. 37 (9), pp. 1345-1360. Date of Electronic Publication: 2023 Apr 13.
DOI:	10.1097/QAD.0000000000003579
Abstrakt:	Objectives: People with HIV (PWH) experience a greater risk of morbidity and mortality following COVID-19 infection, and poorer immunological responses to several vaccines. We explored existing evidence regarding the immunogenicity, effectiveness, and safety of SARS-CoV-2 vaccines in PWH compared with controls. Methods: We conducted a systematic search of electronic databases from January 2020 until June 2022, in addition to conference databases, to identify studies comparing clinical, immunogenicity, and safety in PWH and controls. We compared results between those with low (<350 cells/μl) and high (>350 cells/μl) CD4 + T-cell counts where possible. We performed a meta-analysis of seroconversion and neutralization responses to calculate a pooled risk ratio as the measure of effect. Results: We identified 30 studies, including four reporting clinical effectiveness, 27 immunogenicity, and 12 reporting safety outcomes. PWH were 3% [risk ratio 0.97, 95% confidence interval (95% CI) 0.95-0.99] less likely to seroconvert and 5% less likely to demonstrate neutralization responses (risk ratio 0.95, 95% CI 0.91-0.99) following a primary vaccine schedule. Having a CD4 + T-cell count less than 350 cells/μl (risk ratio 0.91, 95% CI 0.83-0.99) compared with a CD4 + T-cell count more than 350 cells/μl, and receipt of a non-mRNA vaccine in PWH compared with controls (risk ratio 0.86, 95% CI 0.77-0.96) were associated with reduced seroconversion. Two studies reported worse clinical outcomes in PWH. Conclusion: Although vaccines appear well tolerated in PWH, this group experience poorer immunological responses following vaccination than controls, particularly with non-mRNA vaccines and low CD4 + T-cell counts. PWH should be prioritized for mRNA COVID-19 vaccines, especially PWH with more advanced immunodeficiency. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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