Hidoc Bulletin

HIV patients show an increased risk of immunosuppression, hospitalization, and mortality associated with enhanced COVID-19 infection severity & precedence for vaccination. Ageing, multi-mortality & sociodemographic elements determine the COVID-19-related outcome vulnerability in people with HIV. 

Detectable antibody response develops at 3 and 6 months after 2nd dose and 3rd or booster dose. Although COVID-19 vaccines are safe & well tolerated, but viral replication is suppressed in HIV patients & circulating CD4 þ cell numbers do not rebuild properly. 
In HIV patients, possible suppression or overactivation of the immune system is attributable to the primary disease, concurrent treatment & severe infection, and viral shedding.

Attenuated humoral immunity reducing the efficacy of vaccines leads to major gaps in the efficacy of the COVID-19 vaccine in HIV patients. Agitation about the vaccination effectiveness of HIV patients arises due to their reduced serological response regarding other disease vaccinations & high-risk ratio of incomplete, complete & booster vaccination compared to lower rates of seroconversion.

Concerning Points 

There is a large disparity in vaccination coverage in HIV care & viral suppression status leading to a high probability of severe COVID-19 infection outcomes. Simultaneously there is a lack of high efficacy of mRNA COVID-19 vaccines in HIV patients on HAART (Highly active antiretroviral therapy). Concomitantly there is a scarcity of immediate availability of booster doses to combat new recurrent COVID-19 variants. 
Proposed guidelines for COVID-19 Vaccines for the HIV-Infected Patient

1.    Re-establishment of HIV diagnosis, and care services, integrated COVID-19 vaccination & treatment.

2.    Conscious prioritization for COVID-19 surveillance, prevention, and clinical & virological monitoring without any stigmatization. 

3.    Well-supported COVID-19 vaccine accessibility, manufacturing regionalization & monitoring of antiretroviral therapy, & booster dose vaccination. 

4.    Persistent COVID-19 infection irrespective of symptoms virological detection in low CD4 counts (<200 cells/μL) patients. 

5.    Monitoring & vaccination of caretakers, especially in high titers & sequenced isolates. 

6.    More clinical trials to test therapeutic interventions for immunosuppressed patients with persistent COVID-19. 

7.    Initiations of studies to decide between vaccination and long-acting monoclonal antibody prophylaxis.

8.    Developing boosting strategies, neutralizing monoclonal antibodies, and improving access to the rational use of antivirals for potential antiviral-resistant groups who do not respond well to vaccination. 

Conclusions 

Favourable immunogenicity & efficacy of COVID-19 vaccination is observed in HIV patients. Slightly lower improved seroconversion was observed post 2nd dose of vaccination. 3rd  (booster) vaccination with mRNA COVID-19 vaccines may show improvement in seroprotection.  Vaccine hesitancy in HIV patients can be reduced by providing trusted authentic awareness, and information & encouragement by policymakers, health planners & stakeholders. The necessity of booster dose should be prominently established along with developing seriousness towards timely serial dosing to maintain seroprotection.  COVID-19 vaccination clinical guidelines should include vaccine durability, humoral immune response, neutralization capacity & contribution of cell-mediated immunity.