Similar COVID-19 vaccination responses in HIV positive people on ART and with good CD4 counts compared to HIV negative controls

Kirk Taylor, HIV i-Base

A small Canadian cohort reported similar vaccine responses irrespective of HIV status although people living with HIV in the study were on ART with CD4 counts generally above 200 cells/mm3. [1]

The participants living with HIV (n=99) were aged 54 (IQR: 40 to 61), male (88%) and ethnicity was White (69%), Black (5%) or Asian (10%). Recent CD4 counts were 715 cells/mm3 (IQR: 545 to 943) at entry, whilst CD4 nadir was 280 cells/mm3 (IQR: 123 to 490). Viral load was <50 copies/mL on ART.

Control participants (n=152) were aged 47 (IQR: 35 to 70), male (33%) and ethnicity was White (51%), Black (0.7%) or Asian (38%).

Antibody responses were comparable and booster vaccines equally effective for both groups. Although protection against the omicron variant was reduced compared to wild-type virus. Greatest antibody responses were in people that received mRNA boosters.

Lower antibody responses were associated with being older, having co-morbidities and receiving two doses of adenoviral-based vaccines.

However CD4 counts correlate with vaccine response and nearly all participants were >200 cells/mm3 which generates greater antibody responses.

The present study did not detect differences in post-vaccination antibody levels between groups, but it is unclear whether people with HIV that received mRNA vaccines received higher doses, as recommended.


As with many other similar studies, only one or two of the people living with HIV had CD4 counts <200 cells/mm3 which has been linked to reduced antibody responses but neither the paper nor the editorial commented on this.

The authors did not discuss this limitation of the study although an commentary questioned whether immune responses would be lower with unsuppressed viral load and CD4 counts <200 cells/mm3. [2]

Although most people on ART have CD4 counts >200 cells/mm3, late diagnoses is still common, often at CD4 counts where vaccine protection should not be assumed.

Recent studies report lower incidence of breakthrough COVID cases for people with higher CD4 counts, and a greater chance of severe symptoms for those with CD4 counts <350. [3, 4]


  1. Lapointe HR et al. People with HIV receiving suppressive antiretroviral therapy show typical antibody therapy durability after dual COVID-19 vaccination, and strong third dose responses. J. Inf. Dis. DOI:10.1093/infdis/jiac229 (07 June 2022).
  2. Jacobsen JM. Immune responses to SARS-CoV-2 vaccination in people with HIV: A tale of two pandemics. J. Inf. Dis. DOI: 10.1093/infdis/jiac231 (07 June 2022).
  3. Coburn SB et al. Analysis of postvaccination breakthrough COVID-19 infections among adults with HIV in the United States. JAMA. DOI:10.1001/jamanetworkopen.2022.15934 (07 June 2022).
  4. Lang R et al. Analysis of severe illness after post-vaccination COVID-19 breakthroguh among adults with and without HIV in the United States. medRxiv. DOI: 10.1101/2022.04.15.22273913. (16 April 2022).

This report was first published on 26 June 2022.

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