Robust Immunity After COVID-19 Vaccination in People With HIV With High CD4 Count

Illustration of Human Immunodeficiency Virus (HIV) in blood. HIV is a RNA virus from the Retroviridae family that causes acquired immune deficiency syndrome (AIDS).
Researchers assessed the relationship between current CD4 T-cell counts and Immunogenicity after COVID-19 vaccination among people with HIV infection.

Most people living with HIV (PLWH) infection on antiretroviral therapy (ART) achieved a robust humoral and cell-mediated immune response against SARS-CoV-2 infection after vaccination, according to results of a study published in Clinical Infectious Diseases

To investigate vaccine immunogenicity in PLWH, 166 patients with HIV infection receiving ART who were participating in a SARS-CoV-2 vaccination program were enrolled in a prospective immunogenicity evaluation.

Patients received either the BNT162b2 or mRNA-1273 COVID-19 vaccine and were stratified by current CD4 T-cell counts. Poor CD4 recovery (PCDR) was defined as a CD4 T-cell count of less than 200 cells/mm3; intermediate CD4 recovery (ICDR) as a count between 200 and 500 cells/mm3; and high CD4 recovery (HCDR) as a count greater than 500 cells/mm3. The researchers also measured receptor binding domain (RBD)-binding Immunoglobulin (Ig)G, SARS-CoV-2 neutralizing antibodies (nAbs), and interferon-gamma (IFN-γ) release. An unmatched group of healthy health care workers served as the control group.

One month after receipt of the second COVID-19 vaccine dose, detectable RBD-binding IgG was observed in 86.7% of patients in the PCDR group, 100% of those in the ICDR group, and 98.7% of those in the HCDR group. A neutralizing titer at a ratio of 1:10 or greater was observed in 70.0%, 88.2%, and 93.1% of patients in the PCDR, ICDR, and HCDR groups, respectively. After adjustment for confounders, including age, time since HIV diagnosis, CD4 nadir count, HIV viral load, and type of COVID-19 vaccine, a poor magnitude of anti-RDB, nAbs, and IFN-γ response was significantly predictable by current CD4 T-cell counts of less than 200 cells/mm3.

Compared with patients in the HCDR group, all immunogenicity parameters were decreased among those in the PCDR group. Compared with those in the control group, patients in the PCDR group had consistently decreased immunogenicity for all parameters, patients in the ICDR group had a decreased RBD-binding antibody response, and patients in the HCDR group had comparable immunogenicity for all parameters.

This study was limited by its observational design, its underrepresentation of women, and its lack of information on waning vaccine protection due to the short follow-up period.

According to the researchers, “the implications of these findings as correlates of protection of SARS-CoV-2 vaccination in PLWH should be further investigated.”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Antinori A, Cicalini S, Meschi S, et al. Humoral and cellular immune response elicited by mRNA vaccination against SARS-CoV-2 in people living with HIV (PLWH) receiving antiretroviral therapy (ART) according with current CD4 T-lymphocyte count. Clin Infect Dis. Published online April 2, 2022. doi:10.1093/cid/ciac238