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


Between 28 March 2021 and 2 April 2021, 176 PLWH received the COVID-19 vaccine at the YNHHS vaccination site. Of these, 94 individuals consented to participate in our study. We analysed data on 78 subjects at visit 1, excluding 12 individuals who had prior laboratory-confirmed COVID-19 diagnoses, and four subjects whose test results were invalid (Figure 1). In this paper, we present data following the first two study visits.

Figure 1.

Screening and enrolment

Of those eligible for data analysis (n = 78 individuals), 82.1% were aged < 65 years, 34.6% were female, and 53.8% and 6.4% were identified as non-Hispanic blacks and Hispanic whites, respectively (Table 1). At visit 1, the median age of subjects analysed was 61 years of age. A total of 64 subjects were between the ages of 55 and 64 years, and a total of 14 subjects were aged 65–80 years. Of note, patients from a younger population were not included in the study, given state guidelines had only approved COVID-19 vaccination for those aged ≥ 55 years at the time of our research study. Furthermore, 42.3% of participants were obese (BMI ≥ 30 kg/m2). Regarding HIV status, median duration of HIV diagnoses was 9–10 years, all were receiving ART with the majority being on an integrase strand transfer inhibitor (INSTI)-based or INSTI-containing regimen (78.2%); 73.1% had a CD4 count ≥ 500 cells/μL and 83.3% had undetectable HIV viral load. The most common medical comorbidities among participants were cardiovascular disease (37.1%), lung disease (33.3%) and diabetes mellitus (25.6%). Notably, 12.8% also had cancer or other immunocompromising conditions.

At visit 1, 45 of 78 subjects (57.7%) had positive SARS-CoV-2 anti-Spike IgG (Table 2). Bivariate or multivariate analyses did not reveal any statistically significant associations with seroconversion after the first dose, although several key relationships were observed. Our bivariate analyses suggested that participants on an INSTI-based antiretroviral regimen may have been associated with a higher rate of seroconversion after the first dose of COVID-19 vaccine (RR = 1.81, 95% CI: 0.92–3.56, p = 0.085). The direction of this effect estimate was consistent in the multivariate analysis (RR = 1.71, 95% CI: 0.90–3.25, p = 0.10). Our bivariate analyses also suggested that characteristics of CD4 count < 500 cells/μL (RR = 0.59, 95% CI: 0.33–1.05, p = 0.071) and cancer or other immunosuppressive condition (RR = 0.49, 95% CI: 0.18–1.28, p = 0.15) may have been associated with lower rates of seroconversion after the first dose of COVID-19 vaccine. The direction of these findings remained unchanged when included in the multivariate analyses (RRCD4 count < 500 = 0.68, 95% CI: 0.39–1.19, p = 0.18; RRcancer or other immunosuppressive condition = 0.50, 95% CI: 0.19–1.33, p = 0.16).

Of the 78 participants from visit 1, 39 (67.5%) returned for visit 2 (Figure 1). Of these, 38 (97.4%) showed a positive IgG response after the second vaccine dose. Of the 21 subjects with an initial negative IgG at visit 1, 20 (95.2%) had seroconverted after the second dose (Table 2). The only individual with a negative IgG test after the second dose was a solid organ transplant recipient on immunosuppressants (Table 2). Although a substantial proportion of participants from visit 1 did not show up for visit 2, there was little evidence to suggest that this group of individuals differed from those participants who showed up for visit 2 (Table S1).