Immunogenicity to COVID-19 mRNA vaccine third dose in people living with HIV

HIV infection may affect the immune response to vaccination. Here the authors show that humoral response in persons living with HIV after the third dose of a SARS-CoV-2 vaccine is strong and higher than that achieved with the second dose, while cell-mediated immunity remains stable. In order to investigate safety and immunogenicity of SARS-CoV-2 vaccine third dose in people living with HIV (PLWH), we analyze anti-RBD, microneutralization assay and IFN-gamma production in 216 PLWH on ART with advanced disease (CD4 count <200 cell/mm(3) and/or previous AIDS) receiving the third dose of a mRNA vaccine (BNT162b2 or mRNA-1273) after a median of 142 days from the second dose. Median age is 54 years, median CD4 nadir 45 cell/mm(3) (20-122), 93% HIV-RNA < 50 c/mL. In 68% of PLWH at least one side-effect, generally mild, is recorded. Humoral response after the third dose was strong and higher than that achieved with the second dose (>2 log(2) difference), especially when a heterologous combination with mRNA-1273 as third shot is used. In contrast, cell-mediated immunity remain stable. Our data support usefulness of third dose in PLWH currently receiving suppressive ART who presented with severe immune dysregulation.

Automated summary

HIV-infected individuals showed a strong humoral response after the third dose of a SARS-CoV-2 vaccine, while their cell-mediated immunity remained stable. This study highlights the usefulness of a third vaccine dose in people living with HIV who are on suppressive antiretroviral therapy.