Special Session: COVID-19 vaccination and PLWH // La vaccination contre la COVID-19 et les PVVIH
Tracks
Track 1
Track 2
| Friday, April 28, 2023 |
| 7:45 - 8:45 |
| Room 206A |
Details
Description:
People living with HIV (PLWH) may be at risk for poor immunogenicity to certain vaccines, including the ability to develop immunological memory. Thus, achieving and maintaining optimal vaccine-induced immunity is of particular importance for PLWH, notably in the context of emerging viral infections such as COVID-19. This join session between basic and clinical tracks is specifically designed to address the COVID-19 vaccination efficiency and challenges in PLWH.
Learning Objectives:
1) Discuss the latest updates regarding different vaccination strategies and booster efficacy.
2) Review findings of Canadian studies on immune responses following COVID-19 vaccine administration in PLWH compared to uninfected individuals.
3) Examine challenges associated with COVID-19 vaccination in PLWH and racialized and Sex/gender minorities.
Moderator:
Clinical Sciences: Dr. Curtis Cooper (University of Ottawa)
Basic Sciences: Dr. Zabrina Brumme (Simon Fraser University)
Panelists:
Invited speaker, 20 min talk + 5 min Q&A:
• Dr. Andrés Finzi (University of Montreal): COVID-19 vaccination and humoral immune responses
Abstract-driven presentations from both basic and clinical sciences, 10 min talk + 5 min Q&A
• Dr. Vitaliy Matveev (University of Toronto): Three Doses of COVID-19 Vaccines in People with HIV: Immunogenicity and Effects on HIV Reservoir. Submitted initially to the basic sciences.
• Yulia Alexandrova (UQAM): Vaccine-induced SARS-CoV-2-specific T-cell Response after 3 Doses in People Living with HIV on Antiretroviral Therapy Compared to Uninfected Controls.
• Tsegaye Bekele (The Ontario HIV Treatment Network): Uptake of COVD-19, Influenza, and Pneumococcal vaccines among People Living with HIV: Findings from the Ontario HIV Treatment Network Cohort Study.
• Dr. Peter A Newman (University of Toronto): COVID-19 Vaccine Hesitancy, Trust, and Access and Intersectional Challenges among Racialized and Sexual and Gender Minority Persons Living with HIV: Findings from a Scoping Review .
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Description :
Les personnes vivant avec le VIH (PVVIH) risquent de présenter une faible immunogénicité vis-à-vis de certains vaccins, notamment en ce qui concerne la capacité à développer une mémoire immunologique. L'obtention et le maintien d'une immunité optimale induite par les vaccins revêtent donc une importance particulière pour les PVVIH, notamment dans le contexte d'infections virales émergentes telles que la COVID-19. Cette session commune entre les pistes fondamentales et cliniques est spécifiquement conçue pour aborder l'efficacité et les défis de la vaccination contre la COVID-19 chez les PVVIH.
Objectifs d'apprentissage :
1. Discuter des dernières mises à jour concernant les différentes stratégies de vaccination et l'efficacité des rappels.
2. Examiner les résultats des études canadiennes sur les réponses immunitaires après administration du vaccin anti-COVID-19 chez les PVVIH par rapport aux personnes non infectées.
3. Examiner les défis associés à la vaccination anti-COVID-19 chez les PVVIH et les minorités racialisées et de sexe/genre.
Animateurs :
Dr Curtis Cooper (Université d'Ottawa)
Dre Zabrina Brumme (Université Simon Fraser)
Panélistes :
Présentateur invité :
Dr Andrés Finzi (Université de Montréal) Vaccination anti-COVID-19 et réponses immunitaires humorales
Résumés (dans le domaine des sciences fondamentales et cliniques) :
• Dr Vitaliy Matveev (Université de Toronto) : Trois doses de vaccins anti-COVID-19 chez des personnes séropositives : immunogénicité et effets sur le réservoir de VIH). Soumis initialement aux sciences fondamentales.
• Yulia Alexandrova (Université du Québec à Montréal) : Réponse des cellules T spécifiques au SRAS-CoV-2 induite par le vaccin après 3 doses chez les personnes vivant avec le VIH sous traitement antirétroviral par rapport à des témoins non infectés.
• Tsegaye Bekele (Réseau ontarien de traitement du VIH) : Acceptation des vaccins anti-COVID-19, antigrippaux et antipneumococciques chez les personnes vivant avec le VIH : Résultats de l'étude de cohorte du Réseau ontarien de traitement du VIH.
• Dr Peter A. Newman (Université de Toronto) : Hésitation, confiance et accès au vaccin anti-COVI-19 et défis intersectoriels parmi les personnes racialisées et les minorités sexuelles et de genre vivant avec le VIH : Résultats d'un examen approfondi.
Speaker
Yulia Alexandrova
Research Assistant
UQAM
Vaccine-induced SARS-CoV-2-specific T-cell Response after 3 Doses in People Living with HIV on Antiretroviral Therapy Compared to Uninfected Controls
Abstract
Background: People living with HIV (PLWH) may be at risk for poor immunogenicity to certain vaccine, including ability to develop immunological memory. Here we assessed T-cell immunogenicity following three SARS-CoV-2 vaccine doses in PLWH vs uninfected controls.
Methods: Blood was collected from 39 PLWH on ART and 24 age-matched HIV-negative controls pre-vaccination and after 1st/2nd/3rd dose of SARS-CoV-2 vaccine without prior SARS-CoV-2 infection. Flow cytometry was used to assess ex vivo T-cell immunophenotypes and intracellular Tumor necrosis factor (TNF)-α/interferon(IFN)-γ/interleukin(IL)-2 following SARS-CoV-2-Spike-peptide stimulation. Comparisons were made using Wilcoxon signed-rank test for paired variables and Mann–Whitney for unpaired (median percentages shown).
Results: In PLWH, Spike-specific CD4 T-cell frequencies plateaued post-2nd dose, with no significant differences in polyfunctional SARS-CoV-2-specific T-cell proportions between PLWH and uninfected controls post-3rd dose. PLWH had higher frequencies of TNFα+CD4 T-cells (p=0.007) and lower frequencies of IFNγ+CD8 T-cells (p=0.04) than seronegative participants post-3rd dose. Regardless of HIV status, an increase in naive (CD4: HIV+ 19.9 vs 28.6 HIV- 11.5 vs 21.6; CD8: HIV+ 8.5 vs 15.9, HIV- 8.3 vs 20.9; p<0.05), regulatory (HIV+: 0.8 vs 1.6; HIV-: 0.6 vs 1.2; p<0.05), and PD1+ T-cell frequencies (CD4: HIV+ 18.6 vs 20.6, HIV- 9.3 vs 12.2; CD8: HIV+ 22.3 vs 25.0, HIV- 17.0 vs 17.9; p<0.05) was observed post-3rd dose.
Conclusion: Two doses of SARS-CoV-2 vaccine induced robust T-cell immune response in PLWH, which was maintained after the 3rd dose, with no significant differences in polyfunctional SARS-CoV-2-specific T-cell proportions between PLWH and uninfected controls post-3rd dose.
Methods: Blood was collected from 39 PLWH on ART and 24 age-matched HIV-negative controls pre-vaccination and after 1st/2nd/3rd dose of SARS-CoV-2 vaccine without prior SARS-CoV-2 infection. Flow cytometry was used to assess ex vivo T-cell immunophenotypes and intracellular Tumor necrosis factor (TNF)-α/interferon(IFN)-γ/interleukin(IL)-2 following SARS-CoV-2-Spike-peptide stimulation. Comparisons were made using Wilcoxon signed-rank test for paired variables and Mann–Whitney for unpaired (median percentages shown).
Results: In PLWH, Spike-specific CD4 T-cell frequencies plateaued post-2nd dose, with no significant differences in polyfunctional SARS-CoV-2-specific T-cell proportions between PLWH and uninfected controls post-3rd dose. PLWH had higher frequencies of TNFα+CD4 T-cells (p=0.007) and lower frequencies of IFNγ+CD8 T-cells (p=0.04) than seronegative participants post-3rd dose. Regardless of HIV status, an increase in naive (CD4: HIV+ 19.9 vs 28.6 HIV- 11.5 vs 21.6; CD8: HIV+ 8.5 vs 15.9, HIV- 8.3 vs 20.9; p<0.05), regulatory (HIV+: 0.8 vs 1.6; HIV-: 0.6 vs 1.2; p<0.05), and PD1+ T-cell frequencies (CD4: HIV+ 18.6 vs 20.6, HIV- 9.3 vs 12.2; CD8: HIV+ 22.3 vs 25.0, HIV- 17.0 vs 17.9; p<0.05) was observed post-3rd dose.
Conclusion: Two doses of SARS-CoV-2 vaccine induced robust T-cell immune response in PLWH, which was maintained after the 3rd dose, with no significant differences in polyfunctional SARS-CoV-2-specific T-cell proportions between PLWH and uninfected controls post-3rd dose.
Tsegaye Bekele
Senior Lead, Research and Analytics
Ontario HIV Treatment Network
Uptake of COVD-19, Influenza, and Pneumococcal vaccines among People Living with HIV: Findings from the Ontario HIV Treatment Network Cohort Study
Abstract
Background: In Ontario, COVID-19 and Influenza vaccines are available free of charge while Pneumococcal vaccine is covered for older adults (≥65 years) and people with high-risk medical conditions, including HIV. We assessed the uptake of these three vaccines among people living with HIV (PLWH).
Methods: The Ontario HIV Treatment Network Cohort Study (OCS) is a longitudinal cohort of PLWH receiving care in 15 clinics across Ontario. We asked 2,208 OCS participants if they have received COVID-19 (2+ doses), Influenza (in the past year), and Pneumococcal (lifetime) vaccines. Logistic regression modelling was used to identify demographic variables associated with uptake of vaccines.
Results: Overall, the uptake was 93.2% for COVID-19 vaccine, 69.0% for Influenza vaccine, 54.4% for Pneumococcal vaccine, and 40.3% for all three vaccines, with variations by demographic characteristics (see table 1). In multivariable regression analyses, COVID-19 vaccine uptake was not associated with demographic variables; increasing age was associated with higher uptakes of influenza (aOR=1.16, 95% CI: 1.11-1.21) and Pneumococcal (aOR=1.09, 95% CI: 1.03-1.14) vaccines; and PLWH who identified as Black (aOR= 0.72; 95% CI: 0.60 - 0.88) or Latin American (aOR=0.72, 95% CI: 0.53-0.99) and PLWH with less than high school completion (aOR=0.68, 95% CI: 0.53-0.86) had lower uptake of Pneumococcal vaccine.
Discussion: The low uptake of Influenza and Pneumococcal vaccines in PLWH, particularly among young, Black, Latin American, and with low level of education is concerning. Quality improvement initiatives in primary care are needed to ensure that PLWH are up-to-date with all recommended immunizations, including booster doses.
Vitaliy Matveev
Senior Research Associate
University Of Toronto
Three Doses of COVID-19 Vaccines in People with HIV: Immunogenicity and Effects on HIV Reservoir
Abstract
People with HIV (PWH) older than age 55 have an enhanced risk of complications from SARS-CoV-2 infection, but it is unclear whether COVID-19 vaccines with a booster elicit a durable immunity in this population or whether these vaccines can destabilize HIV reservoirs. We followed 68 PWH on cART aged 55 or over and 23 age-matched HIV– controls (CG) over 48 weeks following three doses (D1-3) of COVID-19 vaccines; 42 PWH were immune responders (IR), 20 were non-responders (INR), and 3 had a low-level viremia (LLV). In both groups, vaccines elicited equally strong anti-spike/RBD IgG responses in serum, and spike IgG in saliva. Serum Abs peaked at 4 weeks post-D3. Week 48 serum IgG responses to spike in PWH vs CG were 916 vs 919 BAU/mL, and 706 vs 752 for RBD, respectively. IgA responses in saliva were lower: 3.83%AUC in PWH vs 20.5 in CG (p=0.039). Median neutralizing titers post-D2 were lower in PWH (NT50 82.9 vs 535, p<0.001). However, at 48 weeks, following D3, PWH had similar titers: 309 vs 269 in CG (p=0.745). Anti-spike cytokine T cell responses were the strongest in IRs: week 48 median 135 SFC/106 PBMC vs 43.8 in CG (p<0.001), but only 12.5 in INRs (p=0.001 vs IR). COVID-19 vaccines did not affect the size of intact HIV reservoir in peripheral CD4+ T cells, except in three LLVs: 93.7% mean increase at 48 weeks. PWH aged 55 and over show diminished neutralizing Ab responses to SARS-CoV-2 with two vaccine doses which are ‘rescued’ after a booster. They have lower spike-specific IgA in saliva after vaccination which may affect protection. Enhanced spike T cell immunity in PWH suggests Th1 imprinting from HIV infection. COVID-19 vaccines did not destabilize the HIV reservoir in most PWH but may pose potential risk in unsuppressed viremia.
Peter A Newman
Professor / Factor-Inwentash Faculty of Social Work
University Of Toronto
COVID-19 Vaccine Hesitancy, Trust, and Access and Intersectional Challenges among Racialized and Sexual and Gender Minority Persons Living with HIV: Findings from a Scoping Review
Abstract
Background:
Vaccination is essential to controlling the COVID-19 pandemic; yet, vaccine hesitancy (VH) remains a public health challenge. The WHO Strategic Advisory Group of Experts on Immunization recommends population-, context-, and vaccine-specific research to address VH. We conducted a scoping review to explore multilevel factors associated with COVID-19 VH and broader COVID-19 under-vaccination among marginalized populations in North America.
Methods:
We utilized the scoping review methodology developed by the Joanna Briggs Institute and report results in accordance with PRISMA-ScR guidelines. We searched 9 databases using a search string co-developed with a research librarian. Peer-reviewed articles published from 1/1/20-10/31/21 (initial COVID-19-vaccination), focused on (>50%) marginalized populations, were reviewed using a priori inclusion/exclusion criteria.
Results: The broader search captured 2,496 unique abstracts, scoped to 363 full-text articles, out of which 50 met inclusion criteria. Two articles focused on PLWH; 2 additional provided disaggregated data: medical mistrust, distrust of government contributed to VH, with pandemic-related job loss and housing insecurity associated with lower access. Personal healthcare provider (HCP)-recommendation mitigated VH. Perceived COVID-19 threat and anticipated negative impacts on health were inversely associated with VH, concerns around vaccine safety, side effects and efficacy positively associated with VH. Of 11 articles on racialized populations, 2 addressed PLWH: job loss and logistical constraints (transportation, distance/time) created barriers in access, with VH due to concern the government was withholding information. Personal recommendation from a Black/African-American/Latinx HCP in one’s primary language countered VH and fostered trust. Among gay/bisexual PLWH (1 article), medical mistrust and anticipated discrimination in healthcare settings contributed to VH.
Conclusions: Findings reveal the importance of disaggregating structural barriers in vaccine access from COVID-19 VH and understanding intersectional challenges based on HIV-status, racial/ethnic and sexual identity. Providing COVID-19 vaccination in usual/local healthcare venues, with trusted, same-race/ethnicity/language, LGBTQ-affirmative HCPs may mitigate VH and increase uptake among PLWH.
Vaccination is essential to controlling the COVID-19 pandemic; yet, vaccine hesitancy (VH) remains a public health challenge. The WHO Strategic Advisory Group of Experts on Immunization recommends population-, context-, and vaccine-specific research to address VH. We conducted a scoping review to explore multilevel factors associated with COVID-19 VH and broader COVID-19 under-vaccination among marginalized populations in North America.
Methods:
We utilized the scoping review methodology developed by the Joanna Briggs Institute and report results in accordance with PRISMA-ScR guidelines. We searched 9 databases using a search string co-developed with a research librarian. Peer-reviewed articles published from 1/1/20-10/31/21 (initial COVID-19-vaccination), focused on (>50%) marginalized populations, were reviewed using a priori inclusion/exclusion criteria.
Results: The broader search captured 2,496 unique abstracts, scoped to 363 full-text articles, out of which 50 met inclusion criteria. Two articles focused on PLWH; 2 additional provided disaggregated data: medical mistrust, distrust of government contributed to VH, with pandemic-related job loss and housing insecurity associated with lower access. Personal healthcare provider (HCP)-recommendation mitigated VH. Perceived COVID-19 threat and anticipated negative impacts on health were inversely associated with VH, concerns around vaccine safety, side effects and efficacy positively associated with VH. Of 11 articles on racialized populations, 2 addressed PLWH: job loss and logistical constraints (transportation, distance/time) created barriers in access, with VH due to concern the government was withholding information. Personal recommendation from a Black/African-American/Latinx HCP in one’s primary language countered VH and fostered trust. Among gay/bisexual PLWH (1 article), medical mistrust and anticipated discrimination in healthcare settings contributed to VH.
Conclusions: Findings reveal the importance of disaggregating structural barriers in vaccine access from COVID-19 VH and understanding intersectional challenges based on HIV-status, racial/ethnic and sexual identity. Providing COVID-19 vaccination in usual/local healthcare venues, with trusted, same-race/ethnicity/language, LGBTQ-affirmative HCPs may mitigate VH and increase uptake among PLWH.
