Impaired Antibody Response to COVID-19 Vaccination in Advanced HIV Infection

Nolan Hassold; Ségolène Brichler; Elise Ouedraogo; Delphine Leclerc; Sophie Carroue; Yamina Gater; Chakib Alloui; Etienne Carbonnelle; Olivier Bouchaud; Frederic Mechai; Hugues Cordel; Heloise Delagreverie


AIDS. 2022;36(4):F1-F5. 

In This Article

Abstract and Introduction


Objectives: Coronavirus disease 2019 (COVID-19) vaccination is reportedly efficient in people with HIV (PWH) but vaccine trials included participants with normal CD4+ T-cell counts. We analyzed seroconversion rates and antibody titers following two-dose vaccination in PWH with impaired CD4+ T-cell counts.

Methods: We collected retrospective postvaccination SARS-COV-2 serology results available in a university hospital for PWH vaccinated between March and September, 2021 who were tested for antispike antibodies from 8 to 150 days following dose 2. Antibody titers were compared in PWH with CD4+ T-cell count less than 200 cells/μl, 200 < CD4+ T-cell counts < 500 cells/μl and CD4+ T-cell count greater than 500 cells/μl at vaccination.

Results: One hundred and five PWH were included: n = 54 in the CD4+ T-cell count less than 500 cells/μl group (n = 18 with CD4+ <200 cells/μl, n = 36 with 200 < CD4+ < 500 cells/μl) and 51 in the CD4+ T-cell count greater than 500 cells/μl group. They received two doses of BNT162b2 (75%), mRNA-1273 (8.5%), or ChAdOx1 nCoV-19 (16.5%). The median time from vaccine dose 2 to serology was consistent across all groups (73 days, interquartile range [29–97], P = 0.14). Seroconversion rates were 100% in the CD4+ T-cell count greater than 500 cells/μl group but 89% in participants with CD4+ T-cell counts less than 500 cells/μl (22 and 5.5% seronegative in the CD4+ T-cell counts <200 cells/μl and 200 < CD4+ < 500 cells/μl groups, respectively). Median antibody titers were 623.8 BAU/ml [262.2–2288] in the CD4+ greater than 500 cells/μl group versus 334.3 BAU/ml [69.9–933.9] in the CD4+ less than 500 cells/μl group (P = 0.003). They were lowest in the CD4+ less than 200 cells/μl group: 247.9 BAU/ml [5.88–434.9] (P = 0.0017) with only 44% achieving antibody titers above the putative protection threshold of 260 BAU/ml.

Conclusion: PWH with CD4+ T-cell counts less than 500 cells/μl and notably less than 200 cells/μl had significantly lower seroconversion rates and antispike antibody titers compared with PWH with CD4+ T-cell counts greater than 500 cells/μl, warranting the consideration of targeted vaccine strategies in this fragile population.


In the coronavirus disease 2019 (COVID-19) pandemics, vaccination is key to worldwide healthcare strategies. Safety and efficacy trials of anti-Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) vaccines did include a fraction of immunocompromised participants and secondary analyses focusing on people with HIV (PWH) reported unchanged performances in this population, with both adenoviral and mRNA vaccines.[1–3] Therefore, vaccination guidelines applying to PWH are generally those of the general population. However, these validation studies included a vast majority of PWH on antiretroviral therapy presenting with normal CD4+ T-cell counts. Although HIV-related immunodeficiency and the risk for severe intercurrent infections are higher with the decrease in CD4+ T-cell counts in advanced HIV disease, little data is yet available regarding the efficacy of SARS-COV-2 vaccination in PWH with CD4+ T-cell counts less than 500 cells/μl.

Low rates of antibody seroconversion following vaccination are well documented in other immunosuppressed groups, such as organ recipients and chemotherapy and immunotherapy patients.[4,5] These data prompted population-specific guidelines to enhance protection, including early access to three-dose strategies and customized injection timelines. Furthermore, the value of antispike antibodies as a surrogate marker of vaccine-induced immunity and clinical protection against COVID-19 was emphasized by recent reports of clinically relevant antibody thresholds associated with disease protection.[6,7]

We analyzed postvaccination antibody levels and seroconversion rates in PWH vaccinated with a standard two-dose strategy with CD4+ T-cell counts less than 500 cells/μl and compared them to PWH with conserved CD4+ T-cell counts.