Immunogenicity and Efficacy of COVID-19 Vaccines in People Living with HIV: Systematic Review and Meta-Analysis

Background: Available data show that COVID-19 vaccines may be less effective in people living with HIV (PLWH), who are at increased risk of severe COVID-19. This meta-analysis aimed to compare immunogenicity and efficacy of COVID-19 vaccines in PLWH with healthy individuals.Methods: In this systematic review, we searched Medline, EMBASE, CINAHL, CENTRAL, medRxiv , bioRxiv , and WHO COVID-19 databases for studies published from 1 December 2020 to 10 April 2022. We included prospective studies comparing the immunogenicity and efficacy of COVID-19 vaccines between PLWH and healthy individuals. Relative risks of seroconversion were separately pooled with the use of random effects meta-analysis, and systematic review without meta-analysis of SARS-CoV-2 antibody titre levels was performed after the first and second doses of a COVID-19 vaccine. Risk of bias and certainty of evidence were assessed.Findings: Seventeen studies with 3448 subjects met the inclusion criteria. After first vaccine dose, the pooled RR of seroconversion in PLWH vs healthy individuals was 0.95 (95% CI 0.89-1.03, I 2 = 86%). After a second dose, the pooled RR of seroconversion in PLWH vs healthy controls was 0.95 (0.91-0.99, I 2 = 89%), and antibody titres did not seem to be significantly affected or reduced among participants of both groups.Interpretation: Our review suggests that COVID-19 vaccines show favourable immunogenicity and efficacy in PLWH. A second dose is associated with consistently improved seroconversion, although it is slightly lower in PLWH compared with healthy individuals. Additional strategies, such as the administration of a third (booster) vaccination with mRNA COVID-19 vaccines, might improve seroprotection for these patients. Moreover, all stakeholders should encourage COVID-19 vaccine uptake by providing trusted information and addressing COVID-19 vaccine hesitancy in PLWH.Funding: Science and Technology Department of Henan Province.Declaration of Interest: The authors declare no competing interests.