Immunogenicity, effectiveness and safety of SARS-CoV-2 vaccination in people living with HIV: A systematic review and meta-analysis.

OBJECTIVES: People living with HIV (PLWH) 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 PLWH 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 PLWH 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 neutralisation responses to calculate a pooled risk ratio (RR) as the measure of effect.

RESULTS: We identified thirty studies, including four reporting clinical effectiveness, 27 immunogenicity, and 12 reporting safety outcomes. PLWH were 3% (RR 0.97, 95% CI 0.95-0.99) less likely to seroconvert and 5% less likely to demonstrate neutralisation responses (RR 0.95, 95% CI 0.91-0.99) following a primary vaccine schedule. Having a CD4+ T-cell count <350 cells/μL (RR 0.91, 95% CI 0.83-0.99) compared with a CD4+ T-cell count >350 cells/μL, and receipt of a non-mRNA vaccine in PLWH compared to controls (RR 0.86, 95% CI 0.77-0.96) were associated with reduced seroconversion. Two studies reported worse clinical outcomes in PLWH.

CONCLUSIONS: While vaccines appear safe in PLWH, this group experience poorer immunological responses following vaccination than controls, particularly with non-mRNA vaccines and low CD4+ T-cell counts. PLWH should be prioritized for mRNA COVID-19 vaccines, especially PLWH with more advanced immunodeficiency.