Qualitative Assessment of Anti-SARS-CoV-2 Spike Protein Immunogenicity (QUASI) After COVID-19 Vaccination in Older People Living With HIV

Jessica J. Tuan; Heidi Zapata; Terese Critch-Gilfillan; Linda Ryall; Barbara Turcotte; Suzana Mutic; Laurie Andrews; Michelle E. Roh; Gerald Friedland; Lydia Barakat; Onyema Ogbuagu


HIV Medicine. 2022;23(2):178-185. 

In This Article

Abstract and Introduction


Objectives: Effective and safe COVID-19 vaccines have been developed and have resulted in decreased incidence and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can decrease secondary transmission. However, there are concerns about dampened immune responses to COVID-19 vaccination among immunocompromised patients, including people living with HIV (PLWH), which may blunt the vaccine's efficacy and durability of protection. This study aimed to assess the qualitative SARS-CoV-2 vaccine immunogenicity among PLWH after vaccination.

Methods: We conducted targeted COVID-19 vaccination (all received BNT162b2 vaccine) of PLWH (aged ≥ 55 years per state guidelines) at Yale New Haven Health System and established a longitudinal survey to assess their qualitative antibody responses at 3 weeks after the first vaccination (and prior to receipt of the second dose of the COVID-19 vaccine) (visit 1) and at 2–3 weeks after the second vaccination (visit 2) but excluded patients with prior COVID-19 infection. Our goal was to assess vaccine-induced immunity in the population we studied. Qualitative immunogenicity testing was performed using Healgen COVID-19 anti-Spike IgG/IgM rapid testing. Poisson regression with robust standard errors was used to determine factors associated with a positive IgG response.

Results: At visit 1, 45 of 78 subjects (57.7%) tested positive for SARS-CoV-2 anti-Spike IgG after the first dose of COVID-19 vaccine. Thirty-nine subjects returned for visit 2. Of these, 38 had positive IgG (97.5%), including 20 of 21 subjects (95.2%) with an initial negative anti-Spike IgG. Our bivariate analysis suggested that participants on an antiretroviral regimen containing integrase strand transfer inhibitors [relative risk (RR) = 1.81, 95% confidence interval (CI): 0.92–3.56, p = 0.085] were more likely to seroconvert after the first dose of the COVID-19 vaccine, while those with a CD4 count < 500 cells/μL (RR = 0.59, 95% CI: 0.33–1.05, p = 0.071), and those diagnosed with cancer or another immunosuppressive condition (RR = 0.49, 95% CI: 0.18–1.28, p = 0.15) may have been less likely to seroconvert after the first dose of the COVID-19 vaccine. The direction of these associations was similar in the multivariate model, although none of these findings reached statistical significance (RRintegrase inhibitor = 1.71, 95% CI: 0.90–3.25, p = 0.10; RRCD4 count = 0.68, 95% CI: 0.39–1.19, p = 0.18; RRcancer or another immunosuppressive condition = 0.50, 95% CI: 0.19–1.33, p = 0.16). With regard to immunogenicity, we were able to record very high rates of new seroconversion following the second dose of the COVID-19 vaccine.

Conclusions: Our study suggests that completing a two-dose series of BNT162b2 vaccine is critical for PLWH given suboptimal seroconversion rates after the first dose and subsequent improved seroconversion rates after the second dose.


The COVID-19 pandemic has spurred the rapid development of safe and highly effective vaccines to prevent infection with and transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus.[1,2] The observed high vaccine efficacy in Phase 3 COVID-19 vaccine trials are a direct result of robust adaptive immune responses generated following vaccination as were observed in the preceding Phase 1/2 trials.[3] However, in the initial phase of early vaccine clinical trials, limited immunogenicity data regarding immunocompromised individuals who may have impaired immune response after vaccination were included in the first wave of vaccine trials. Since then, increasing data regarding COVID-19 vaccination amongst people living with HIV (PLWH) have emerged.[4–6]

Additionally, emerging evidence has shown that certain immunocompromised groups, such as transplant recipients, exhibit poor immunogenicity to an initial dose of SARS-CoV-2 vaccines,[7,8] with seroconversion rates of just 17% in one study.[7] Similar reports have emerged about patients with multiple myeloma after first vaccination with BNT162b2 and ChAdOx1 nCoV-19 vaccines.[9] These observations are not unexpected and are anticipated in other immunocompromised groups. The objective of our study was to assess the qualitative SARS-CoV-2 immunogenicity of PLWH after COVID-19 vaccination and its durability. We hypothesized that PLWH will have decreased immunoglobulin G (IgG) seroconversion rates following COVID-19 vaccination, particularly the first dose, compared with patients in the registration clinical trials – thus, we hypothesized that this decreased IgG seroconversion would prompt the need for second-dose vaccination.