背景:目前批准的SARS-CoV-2疫苗已被证明可有效预防严重的COVID-19;然而,它们对有症状的感染和疾病传播表现出不同的功效。我们研究了在HIV感染者(PWH)中加强接种SARS-CoV-2疫苗后突破性的COVID-19感染(BTI)。
方法:这是一个回顾性研究,单中心,涉及PWH的描述性队列研究,在雅典“Attikon”大学医院的艾滋病毒诊所被跟踪,希腊。BTI定义为在第三次(加强)疫苗剂量后至少14天发生实验室确认的COVID-19病例。
结果:我们研究了733个PWH[男性:89%,平均年龄:45.2±11.3岁,平均BMI:26.1±4.1,诊断时的HIV分期(CDC分类):A/B/C=80/9/11%,MSM:72.6%]HIV感染控制良好。在54%的病例中记录到至少一种合并症。90%的人报告了≥1次疫苗接种史,75%的人接种了≥3种疫苗。四百零二(55%)PWH有COVID-19的病史,302(41.2%)有BTI,只有15人(3.7%)需要住院治疗。只有一个病人被送进了ICU,没有死亡报告。关于加强剂量后的BTI,年龄增加(OR=0.97,95%CI:0.96-0.99,每1年增加),加强剂量前COVID-19感染(OR=0.38,95%CI:0.21-0.68)与BTI的可能性较低相关,而较高的BMI(OR=1.04,95%CI:1.01-1.08)和作为HIV传播方式的MSM与风险增加相关(OR=2.59,95%CI:1.47-4.56).总COVID-19和BTI的发病率遵循一般人群的流行曲线,发病率最高的是2022年6月。
结论:HIV感染控制良好的PWH中有很大一部分经历了BTI,其中大多数患有轻度感染。这些数据,其中包括Omicron变体占主导地位的时期,确认疫苗接种在预防严重COVID-19中的重要性。
BACKGROUND: Currently approved SARS-CoV-2 vaccines have been proven effective in protecting against severe COVID-19; however, they show variable efficacy against symptomatic infection and disease transmission. We studied the breakthrough COVID-19 infection (BTI) after booster vaccination against SARS-CoV-2 in people living with HIV (PWH).
METHODS: This was a retrospective, single-center, descriptive cohort study involving PWH, who were followed in the HIV Clinic of \"Attikon\" University Hospital in Athens, Greece. A BTI was defined as a case of laboratory-confirmed COVID-19 occurring at least 14 days after the third (booster) vaccine dose.
RESULTS: We studied 733 PWH [males: 89%, mean age: 45.2 ± 11.3 years, mean BMI: 26.1 ± 4.1, HIV stage at diagnosis (CDC classification): A/B/C = 80/9/11%, MSM: 72.6%] with well-controlled HIV infection. At least one comorbidity was recorded in 54% of cases. A history of ≥1 vaccination was reported by 90%, with 75% having been vaccinated with ≥3 vaccines. Four hundred and two (55%) PWH had a history of COVID-19 and 302 (41.2%) had a BTI, with only 15 (3.7%) needing hospitalization. Only one patient was admitted to the ICU, and no death was reported. Regarding BTI after booster dose, increased age (OR = 0.97, 95% CI: 0.96-0.99, per 1-year increase), and COVID-19 infection prior to booster dose (OR = 0.38, 95% CI: 0.21-0.68) were associated with a lower likelihood for BTI, whereas higher BMI (OR = 1.04, 95% CI: 1.01-1.08) and MSM as a mode of HIV transmission were associated with increased risk (OR = 2.59, 95% CI: 1.47-4.56). The incidence rate of total COVID-19 and BTI followed the epidemic curve of the general population, with the highest incidence recorded in June 2022.
CONCLUSIONS: A significant proportion of PWH with well-controlled HIV infection experienced a BTI, with the majority of them having mild infection. These data, which include the period of Omicron variant predominance, confirm the importance of vaccination in the protection against severe COVID-19.