{"id":40779,"date":"2021-07-01T06:33:53","date_gmt":"2021-07-01T06:33:53","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=40779"},"modified":"2021-09-01T07:01:43","modified_gmt":"2021-09-01T07:01:43","slug":"failure-of-mrna-vaccines-to-produce-antibody-responses-in-late-diagnosed-hiv-with-low-cd4-count-and-high-viral-load","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/40779","title":{"rendered":"mRNA vaccine fails to produce antibody response in late-stage HIV: low CD4 count and high viral load"},"content":{"rendered":"
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<\/span>Simon Collins, HIV i-Base<\/strong><\/p>\n<\/div>\n

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A letter to the 1 June 2021 edition of the Lancet HIV reports a UK case of someone diagnosed HIV positive in late infection 16 days after the second dose of the Pfizer mRNA vaccine. The vaccine failed to produce antibody responses. [1]<\/span><\/strong><\/p>\n<\/div>\n

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This person was included in a study that included HIV positive people on effective ART and also responses in HIV negative controls.<\/span><\/p>\n<\/div>\n

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At baseline high HIV viral load was high (831,764 copies\/mL) and the CD4 count was low (20 cells\/mm3<\/sup>, indicating likely late diagnosis (rather that recent seroconversion). The CD4% was 4.6% and CD4:CD8 ratio was 0.05. <\/span>No SARS-CoV-2-specific neutralisation or spike-specific T-cell responses were found at days 16 and 44 after the second vaccine.<\/p>\n<\/div>\n

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This case was part of a cohort looking at vaccine responses that included 13 HIV positive people on stable ART (<\/span>median CD4 count 590 cells\/mm3<\/sup>(range: 310 to 940) and 43 HIV-negative controls, [2]<\/p>\n<\/div>\n

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The majority of HIV positive people mounted SARS-specific antibodies with neutralising activity and T cell responses.<\/p>\n<\/div>\n

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The letter suggests careful monitoring for COVID-19 in people with very low CD4 counts and repeating the vaccine schedule after increased CD4 responses to ART.<\/span><\/p>\n<\/div>\n

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As follow-up, within one month on ART (bictegravir\/TAF\/FTC), the CD4 count in this case increased to 70 cells\/mm3<\/sup> and HIV viral load was <50 copies\/mL.<\/span><\/p>\n<\/div>\n

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comment<\/span><\/h3>\n<\/div>\n
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Although limited results support the efficacy of COVID-19 vaccines in HIV positive people COVID-19, these data are generally in people with an undetectable viral load in people on stable ART. [3]<\/span><\/strong><\/p>\n<\/div>\n

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The mechanism for caution on vaccine efficacy is that a lower HIV-related CD4 count might be less able to generate B-cell responses to vaccine, which we know is already the case with vaccines against influenza and hepatitis B.<\/span><\/strong><\/p>\n<\/div>\n

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This case highlights the lack of data on vaccine efficacy in the context of HIV viraemia. This is especially when the CD4 count is also low.\u00a0<\/span><\/strong>Although the threshold CD4 count for vaccine response is not known, this should be an additional monitoring recommendation in all cases of late HIV diagnosis.<\/span><\/strong><\/p>\n<\/div>\n

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An interesting paper in the same issue of Lancet HIV (Spinelli et al) reported potentially lower immune responses to natural infection in a cohort of HIV positive people in San Francisco and that they had higher risks of serious outcomes. [4]<\/span><\/strong><\/p>\n<\/div>\n<\/div>\n

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Reference<\/span><\/p>\n<\/div>\n

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  1. Touizer E et al. Failure to seroconvert after two doses of BNT162b2 SARS-CoV-2 vaccine in a patient with uncontrolled HIV. Lancet HIV, correspondence. 8(6):e317\u2013318. DOI: 10.1016\/S2352-3018(21)00099-0. (1 June 2021).
    \n<\/span>https:\/\/www.thelancet.com\/journals\/lanhiv\/article\/PIIS2352-3018(21)00099-0\/fulltext<\/a><\/li>\n
  2. Alrubayyi A et al. Characterization of humoral and SARS-CoV-2 specific T cell responses in people living with HIV. bioRxiv. 2021 preprint. DOI: 10.1101\/2021.02.15.431215. (16 Feb 2021).
    \n    https:\/\/www.biorxiv.org\/content\/10.1101\/2021.02.15.431215v1<\/a><\/li>\n
  3. Collins S. Similar immune responses to the Oxford\/AZ COVID vaccine reported In HIV positive and HIV negative participants. HTB (3 May 2021).
    \n    https:\/\/i-base.info\/htb\/40465<\/a><\/li>\n
  4. Spinelli MA et al. <\/span>SARS-CoV-2 seroprevalence, and IgG concentration and pseudovirus neutralising antibody titres after infection, compared by HIV status: a matched case-control observational study Lancet HIV. 8(6):e334\u20133421.DOI: <\/span>10.1016\/S2352-3018(21)00072-2. (1 June 2021).
    \n    https:\/\/www.thelancet.com\/journals\/lanhiv\/article\/PIIS2352-3018(21)00072-2\/fulltext<\/a><\/li>\n<\/ol>\n

    This article was first published on 3 June 2021.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base A letter to the 1 June 2021 edition of the Lancet HIV reports a UK case of someone diagnosed HIV positive in late infection 16 days after the second dose of the Pfizer mRNA vaccine. The …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[282,292,278],"tags":[],"class_list":["post-40779","post","type-post","status-publish","format-standard","hentry","category-covid-19-hiv-and-covid-19-coinfection","category-covid-19-vaccine","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40779","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=40779"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40779\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=40779"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=40779"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=40779"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}