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HIV patients with low viral load and high CD4 count are unlikely to need a third dose of the COVID-19 vaccine.

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Multiple chronic illnesses, the elderly, or the Oxford / AstraZeneca vaccine may increase the need for a third dose

HIV patients whose viral load is well controlled by antiretroviral treatment have levels of antibody similar to those of HIV-negative people after two doses of the SARS-CoV-2 vaccine, most often the third. Canadian researchers report that the virus does not need to be vaccinated.

However, they found that those who received the Oxford / AstraZeneca vaccine twice had lower antibody levels after the second dose than those who received the other vaccines. Antibody levels were also low in the elderly and those with multiple underlying health conditions.

Findings from a study of 100 HIV-infected persons and 152 HIV-negative controls in Vancouver, Canada, are published as peer-reviewed preprinted articles.

Glossary

Multivariate analysis

A commonly used statistical technique to reduce the effects of confounding factors in an attempt to identify the actual association between the factor of interest and the outcome.

Control group

A group of study participants who receive standard treatment or no treatment at all, rather than treatment during the study. Also called a control arm.

log

An abbreviation for logarithm, a measurement scale often used to describe viral load. A single log change is a 10x change, such as 100 to 10. The two log changes are 100x changes, such as 1,000 to 10.

Drug interaction

A dangerous combination of drugs if drug A interferes with the function of drug B. Blood levels of the drug may decrease or increase, impairing its effectiveness or exacerbating side effects. Also known as drug-drug interactions.

p-value

The result of a statistical test that indicates whether the results of the survey are likely to be accidental and will not be confirmed if the survey is repeated. All p values ​​are between 0 and 1. The p-value for the most reliable studies is very close to 0. A p value of 0.001 means that the result is accidental and there is a 1 in 1000 chance that it does not reflect the actual difference. A p value of 0.05 means that there is a 1 in 20 chance that the result is accidental. Results are considered “statistically significant” if the p-value is less than or equal to 0.05. Confidence intervals provide information similar to p-values, but are easier to interpret.

Health officials in several countries, including the United States, recommend that HIV patients with low CD4 counts should be vaccinated with a third dose to improve their immune response to SARS-CoV-2. However, little information is available on the immune response to the standard course of SARS-CoV-2 vaccination of HIV patients on which the recommendations are based, and few HIV patients have been included in clinical trials of the Pfizer or Modelna vaccines.

A Canadian researcher, led by Professor Zabrina Brumme of the University of Simon Fraser, British Columbia, conducted 100 HIVs through three HIV clinics in Vancouver to better understand the immune response of HIV-infected persons to SARS-CoV-2 vaccination. We recruited infected people. The HIV-negative control group included 24 health care workers under the age of 65, 39 over the age of 65, and 89 health care workers already participating in another study. They took blood samples, if possible, before vaccination, one month after the first vaccination, and one month after the second vaccination.

The median age of HIV-infected persons was 54 years, 88% were male and 69% were Caucasian, and chronic health was rare among study participants. All people infected with HIV were receiving antiretroviral treatment, and the latest viral load was less than 50 copies / ml. Participants had a median CD4 number of 710 and a median CD4 number of 280.

The HIV-negative control group was predominantly female (67%), less likely to be white (51%) than the HIV-positive group, and more likely to be vaccinated with Pfizer or Moderna mRNA than HIV patients (97%). The sex was high. 83%). Eight percent of HIV patients received two doses of the Oxford / AstraZeneca vaccine, seven percent received one dose of the Oxford / AstraZeneca vaccine, and one dose of the Pfizer or Moderna mRNA vaccine.

In Canada, a second dose with the mRNA vaccine was recommended for all people who received the Oxford / AstraZeneca vaccine after reporting a rare thrombotic event, so use different vaccines for the first and second doses. Was common.

The median interval between first and second vaccinations is HIV-infected because initial restrictions on the supply of vaccinations have increased the time for the first vaccinated health care worker to wait for the second vaccination. The control group was longer than those in the control group (89 days vs. 58 days). I was vaccinated later.

Blood samples were tested for the total number of SARS-CoV-2 antibodies and the ability of the antibody to block the interaction between the virus and the ACE2 receptor that the virus uses to invade cells.

Pre-vaccinated blood samples were available to 66% of HIV-infected individuals and 97% of controls. They showed that 8% of HIV-infected individuals and 10% of the control group had antibodies to SARS-CoV-2 prior to vaccination.

After the first dose, antibody levels in HIV patients were slightly lower (-0.4 log lower, p = 0.0001), but after the second dose, antibody levels in both HIV patients and controls increased by 2 logs, and antibody levels. The difference between HIV and people with control decreased to -0.1 log (p = 0.04).

Multivariate analysis showed that HIV was not associated with decreased antibody levels after the second dose. Instead, decreased antibody levels are associated with a high number of underlying chronic health conditions, two doses of the Oxford / AstraZeneca vaccine, or extra age every 10 years. I did.

There was no correlation between the latest CD4 count or the lowest CD4 count after the second dose and antibody levels.

“After the second dose, HIV was not associated with decreased antibody levels.”

Looking at ACE2 substitution (blocking the interaction between the virus and the ACE2 receptor), the activity of the HIV patients and the control group after the second dose was similar. Again, multivariate analysis showed that aging, increased numbers of chronic illnesses, or double doses of the Oxford / AstraZeneca vaccine were each associated with low activity.

Two doses of the Oxford / AstraZeneca vaccine resulted in a substantially greater loss of displacement activity than in the elderly and chronic illnesses.

In all measurements, HIV was associated with impaired response after one dose of vaccine, but not after two doses. This indicates that HIV patients have a slightly weaker response to vaccination after a single vaccination, emphasizing the importance of receiving both vaccinations at recommended intervals for HIV-infected individuals. increase.

Those who had antibodies to SARS-CoV-2 before vaccination showed significantly higher antibody levels than those who did not have them after a single vaccination. The second vaccination did not significantly increase antibody levels in this group. They also showed very strong substitution activity after a single dose of vaccine and maintained significantly higher levels of substitution activity after a second dose than those without a history of COVID-19.

Researchers conclude that HIV patients who suppress viral load and healthy CD4 counts in most cases do not require a third vaccination, but age, other chronic health conditions, and Vaccine regimens can influence advice regarding the need for boosters. They also state that low CD4 counts in the past do not appear to impair the response of the vaccine. However, they warn that further research is needed on the vaccine response in this group, as there are currently only two study participants with CD4 counts less than 250.

Sources

1/ https://Google.com/

2/ https://www.aidsmap.com/news/oct-2021/people-hiv-suppressed-viral-load-and-higher-cd4-counts-unlikely-need-third-dose-covid

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