Severe acute respiratory syndrome coronavirus-2 antibody prevalence in adults with HIV

To measure severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibody seroprevalence within a cohort of adults with HIV and correlate demographics with response rates to SARS CoV-2 vaccination.

Initial vaccine trials for SARS CoV-2 did not examine efficacy in people with HIV. We undertook the SCAPE-HIV study from April 2021 to November 2022 to focus on vaccine response in this population to guide future vaccine scheduling.

Participants completed a retrospective questionnaire. Nucleocapsid and spike antibodies to SARS CoV-2 (anti-N and anti-S) were tested. Demographic and HIV factors (CD4 + cell count, viral load) were correlated with quantitative serological outcomes. Anti-S titres less than 400 U/ml were considered low level. Follow-up was performed in a subset post third vaccination.

Six hundred and twelve participants completed the study questionnaire, 520 were included in the final analysis. Most participants received either ChAdOx1-S recombinant vaccine or the BNT162b2 mRNA vaccine for the first two doses. Almost all participants (99.2%) in the main group had an anti-S antibody detected above the assay cutoff (>0.8 U/ml). Most participants (77.3%) had anti-S titres greater than 400 U/ml, with the median titre 1734 U/ml. Age over 60 years was significantly associated with lower (<400 U/ml) anti-S antibody titre ( P  < 0.0001).

We demonstrate a high rate of anti-S seropositivity following SARS-CoV-2 vaccination in people with HIV. Age over 60 was the only parameter found to be associated with a lower anti-S antibody titre. Our findings suggest that COVID-19 vaccine scheduling should target older persons with HIV in line with the general population.