SARS-CoV-2 vaccination in people with HIV.
SARS-CoV-2 vaccination in people with HIV.
复制标题
DOI：
10.1016/s2352-3018(21)00128-4
复制
发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Spinelli MA
中科院分区：
文献类型：
--
作者：
Spinelli MA
在COVID-19大流行的这一点上，随着疫苗的推出，艾滋病毒感染者及其医疗保健提供者面临的最紧迫的问题是艾滋病毒是否会调节SARS-CoV-2疫苗预防严重COVID-19疾病的免疫反应和随后的有效性。关于艾滋病毒是否会增加严重COVID-19风险的数据相互矛盾，初步研究显示，过度风险与严重COVID-19相关的其他合并症的存在有关。然而，随后在更大和更多样化的人群队列中进行的研究表明，CD 4细胞计数较低或病毒载量未受抑制的HIV感染者患严重COVID-19的风险可能会增加。1，2 SARS-CoV-2疫苗接种有望大幅降低这种风险，尽管缺乏艾滋病毒特异性数据。艾滋病毒感染者对乙型肝炎3和黄热病疫苗接种的反应减弱或不太持久，4而CD 4细胞计数低的人对白喉、破伤风和脊髓灰质炎的抗体滴度降低。5 HIV阳性人群的免疫应答强度低于HIV阴性人群，或免疫应答持续时间较短，这被认为是由较低的CD 4/CD 8比值、T细胞耗竭或与HIV感染相关的持续炎症介导的，尽管进行了有效的抗逆转录病毒治疗（ART）。3自然感染SARS-CoV-2后，HIV感染者的抗刺突IgG浓度和假病毒中和滴度较低。6对于其他免疫妥协条件，如实体器官移植，已记录了SARS-CoV-2 mRNA疫苗接种的免疫原性降低，其他条件的数据也出现了。7 Novavax COVID-19疫苗研究南非研究中心的研究人员报告说，当艾滋病毒感染者被纳入分析时，有效性从60%（95%CI 20-80）下降到49%（6-73），尽管这些数据尚未公布。8关注
At this point in the COVID-19 pandemic, with vaccine roll-out ongoing, the most urgent question facing people with HIV and their health-care providers is whether HIV modulates the immune response to and subsequent effectiveness of the SARS-CoV-2 vaccines in preventing severe COVID-19 disease. Data on whether HIV increases the risk of severe COVID-19 are conflicting, with initial studies showing that excess risk was associated with the presence of other comorbidities associated with severe COVID-19. 1 However, subsequent investigations in larger and more diverse populationbased cohorts have suggested that people with HIV with lower CD4 cell counts or unsuppressed viral loads might be at increased risk of severe COVID-19. 1, 2 SARS-CoV-2 vaccination is expected to substantially reduce this risk, although there is a paucity of HIV-specific data. People living with HIV have diminished or less durable response to hepatitis B3 and yellow fever vaccination, 4 and people with low CD4 cell counts have diminished antibody titres to diphtheria, tetanus, and poliomyelitis. 5 This lower magnitude or less durable immune response in HIV-positive populations than in the HIV-negative population is thought to be mediated by lower CD4/CD8 ratios, T-cell exhaustion, or persistent inflammation related to HIV infection despite effective antiretroviral therapy (ART). 3 After natural infection withSARS-CoV-2, people with HIV have lower anti-spike IgG concentrations and pseudovirus neutralising titres. 6 For other immunocompromising conditions, such as solid organ transplantation, decreased immunogenicity to SARS-CoV-2 mRNA vaccination has been documented, with data emerging for other conditions. 7 Investigators from the Novavax COVID-19 vaccine study’s South African sites reported that efficacy decreased from 60%(95% CI 20–80) to 49%(6–73) when people living with HIV were included in the analysis, although these data have not yet been published. 8 These concerns