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Matveev VA, Mihelic EZ, Benko E, Budylowski P, Grocott S, Lee T, Korosec CS, Colwill K, Stephenson H, Law R, Ward LA, Sheikh-Mohamed S, Mailhot G, Delgado-Brand M, Pasculescu A, Wang JH, Qi F, Tursun T, Kardava L, Chau S, Samaan P, Imran A, Copertino DC, Chao G, Choi Y, Reinhard RJ, Kaul R, Heffernan JM, Jones RB, Chun TW, Moir S, Singer J, Gommerman J, Gingras AC, Kovacs C, Ostrowski M. Immunogenicity of COVID-19 vaccines and their effect on HIV reservoir in older people with HIV. iScience 2023; 26:107915. [PMID: 37790281 PMCID: PMC10542941 DOI: 10.1016/j.isci.2023.107915] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
Older individuals and people with HIV (PWH) were prioritized for COVID-19 vaccination, yet comprehensive studies of the immunogenicity of these vaccines and their effects on HIV reservoirs are not available. Our study on 68 PWH and 23 HIV-negative participants aged 55 and older post-three vaccine doses showed equally strong anti-spike IgG responses in serum and saliva through week 48 from baseline, while PWH salivary IgA responses were low. PWH had diminished live-virus neutralization responses after two vaccine doses, which were 'rescued' post-booster. Spike-specific T cell immunity was enhanced in PWH with normal CD4+ T cell count, suggesting Th1 imprinting. The frequency of detectable HIV viremia increased post-vaccination, but vaccines did not affect the size of the HIV reservoir in most PWH, except those with low-level viremia. Thus, older PWH require three doses of COVID-19 vaccine for maximum protection, while individuals with unsuppressed viremia should be monitored for adverse reactions from HIV reservoirs.
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Affiliation(s)
- Vitaliy A. Matveev
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Erik Z. Mihelic
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Erika Benko
- Maple Leaf Medical Clinic, Toronto ON M5G 1K2, Canada
| | - Patrick Budylowski
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
- Institute of Medical Science, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Sebastian Grocott
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
- Department of Microbiology and Immunology, McGill University, Montreal QC H3A 2B4, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network (CTN), Vancouver BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver BC V6Z IY6, Canada
| | - Chapin S. Korosec
- Modelling Infection and Immunity Lab, Mathematics and Statistics Department, York University, Toronto ON M3J 1P3, Canada
- Centre for Disease Modelling, Mathematics and Statistics Department, York University, Toronto ON M3J 1P3, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto ON M5G 1X5, Canada
| | - Henry Stephenson
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
- Department of Bioengineering, McGill University, Montreal QC H3A 0E9, Canada
| | - Ryan Law
- Department of Immunology, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Lesley A. Ward
- Department of Immunology, University of Toronto, Toronto ON M5S 1A8, Canada
| | | | - Geneviève Mailhot
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto ON M5G 1X5, Canada
| | | | - Adrian Pasculescu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto ON M5G 1X5, Canada
| | - Jenny H. Wang
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto ON M5G 1X5, Canada
| | - Freda Qi
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto ON M5G 1X5, Canada
| | - Tulunay Tursun
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto ON M5G 1X5, Canada
| | - Lela Kardava
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Serena Chau
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Philip Samaan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Annam Imran
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Dennis C. Copertino
- Infectious Diseases, Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA
| | - Gary Chao
- Department of Immunology, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Yoojin Choi
- Department of Immunology, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Robert J. Reinhard
- Independent Public/Global Health Consultant, San Francisco, CA 94114, USA
| | - Rupert Kaul
- Department of Immunology, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Jane M. Heffernan
- Modelling Infection and Immunity Lab, Mathematics and Statistics Department, York University, Toronto ON M3J 1P3, Canada
- Centre for Disease Modelling, Mathematics and Statistics Department, York University, Toronto ON M3J 1P3, Canada
| | - R. Brad Jones
- Infectious Diseases, Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, USA
| | - Tae-Wook Chun
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Susan Moir
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Joel Singer
- CIHR Canadian HIV Trials Network (CTN), Vancouver BC V6Z 1Y6, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver BC V6Z IY6, Canada
- School of Population and Public Health, University of British Columbia, Vancouver BC V6T 1Z3, Canada
| | - Jennifer Gommerman
- Department of Immunology, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto ON M5G 1X5, Canada
- Department of Molecular Genetics, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Colin Kovacs
- Maple Leaf Medical Clinic, Toronto ON M5G 1K2, Canada
- Department of Internal Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
| | - Mario Ostrowski
- Department of Medicine, University of Toronto, Toronto ON M5S 1A8, Canada
- Department of Immunology, University of Toronto, Toronto ON M5S 1A8, Canada
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health, Toronto ON M5B 1W8, Canada
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Matveev VA, Mihelic EZ, Benko E, Budylowski P, Grocott S, Lee T, Korosec CS, Colwill K, Stephenson H, Law R, Ward LA, Sheikh-Mohamed S, Mailhot G, Delgado-Brand M, Pasculescu A, Wang JH, Qi F, Tursun T, Kardava L, Chau S, Samaan P, Imran A, Copertino DC, Chao G, Choi Y, Reinhard RJ, Kaul R, Heffernan JM, Jones RB, Chun TW, Moir S, Singer J, Gommerman J, Gingras AC, Kovacs C, Ostrowski M. Immunogenicity of COVID-19 vaccines and their effect on the HIV reservoir in older people with HIV. bioRxiv 2023:2023.06.14.544834. [PMID: 37502977 PMCID: PMC10370192 DOI: 10.1101/2023.06.14.544834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Older individuals and people with HIV (PWH) were prioritized for COVID-19 vaccination, yet comprehensive studies of the immunogenicity of these vaccines and their effects on HIV reservoirs are not available. We followed 68 PWH aged 55 and older and 23 age-matched HIV-negative individuals for 48 weeks from the first vaccine dose, after the total of three doses. All PWH were on antiretroviral therapy (cART) and had different immune status, including immune responders (IR), immune non-responders (INR), and PWH with low-level viremia (LLV). We measured total and neutralizing Ab responses to SARS-CoV-2 spike and RBD in sera, total anti-spike Abs in saliva, frequency of anti-RBD/NTD B cells, changes in frequency of anti-spike, HIV gag/nef-specific T cells, and HIV reservoirs in peripheral CD4 + T cells. The resulting datasets were used to create a mathematical model for within-host immunization. Various regimens of BNT162b2, mRNA-1273, and ChAdOx1 vaccines elicited equally strong anti-spike IgG responses in PWH and HIV - participants in serum and saliva at all timepoints. These responses had similar kinetics in both cohorts and peaked at 4 weeks post-booster (third dose), while half-lives of plasma IgG also dramatically increased post-booster in both groups. Salivary spike IgA responses were low, especially in INRs. PWH had diminished live virus neutralizing titers after two vaccine doses which were 'rescued' after a booster. Anti-spike T cell immunity was enhanced in IRs even in comparison to HIV - participants, suggesting Th1 imprinting from HIV, while in INRs it was the lowest. Increased frequency of viral 'blips' in PWH were seen post-vaccination, but vaccines did not affect the size of the intact HIV reservoir in CD4 + T cells in most PWH, except in LLVs. Thus, older PWH require three doses of COVID-19 vaccine to maximize neutralizing responses against SARS-CoV-2, although vaccines may increase HIV reservoirs in PWH with persistent viremia.
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Affiliation(s)
| | - Erik Z. Mihelic
- Dept of Medicine, University of Toronto, Toronto, ON, Canada
| | - Erika Benko
- Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - Patrick Budylowski
- Dept of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sebastian Grocott
- Dept of Medicine, University of Toronto, Toronto, ON, Canada
- Dept of Microbiology and Immunology, McGill University, Montreal, QC, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, BC, Canada
| | - Chapin S. Korosec
- Modelling Infection and Immunity Lab, Mathematics and Statistics Dept, York University, Toronto, ON, Canada
- Centre for Disease Modelling, Mathematics and Statistics Dept, York University, Toronto, ON, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Henry Stephenson
- Dept of Medicine, University of Toronto, Toronto, ON, Canada
- Dept of Bioengineering, McGill University, Montreal, QC, Canada
| | - Ryan Law
- Dept of Immunology, University of Toronto, Toronto, ON, Canada
| | - Lesley A. Ward
- Dept of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Geneviève Mailhot
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | | | - Adrian Pasculescu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Jenny H. Wang
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Freda Qi
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Tulunay Tursun
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Lela Kardava
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Serena Chau
- Dept of Medicine, University of Toronto, Toronto, ON, Canada
| | - Philip Samaan
- Dept of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Annam Imran
- Dept of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dennis C. Copertino
- Infectious Diseases, Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Gary Chao
- Dept of Immunology, University of Toronto, Toronto, ON, Canada
| | - Yoojin Choi
- Dept of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Rupert Kaul
- Dept of Immunology, University of Toronto, Toronto, ON, Canada
| | - Jane M. Heffernan
- Modelling Infection and Immunity Lab, Mathematics and Statistics Dept, York University, Toronto, ON, Canada
- Centre for Disease Modelling, Mathematics and Statistics Dept, York University, Toronto, ON, Canada
| | - R. Brad Jones
- Infectious Diseases, Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
- Dept of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tae-Wook Chun
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Susan Moir
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Joel Singer
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Dept of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Colin Kovacs
- Maple Leaf Medical Clinic, Toronto, ON, Canada
- Dept of Internal Medicine, University of Toronto, Toronto, ON, Canada
- Senior authors
| | - Mario Ostrowski
- Dept of Medicine, University of Toronto, Toronto, ON, Canada
- Dept of Immunology, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
- Senior authors
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Malazogu F, Rousseau RK, Shivappa N, Huibner S, Walmsley SL, Kovacs CM, Benko E, Reinhard RJ, Rosenes R, Hebert JR, Kaul R. The Dietary Inflammatory Index Is Not Associated With Gut Permeability or Biomarkers of Systemic Inflammation in HIV Immunologic Non-responders. Front Nutr 2021; 8:736816. [PMID: 34881278 PMCID: PMC8646029 DOI: 10.3389/fnut.2021.736816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Immunologic non-responders (INRs) are a subset of individuals living with HIV who have suboptimal blood CD4+ T cell recovery despite effective antiretroviral therapy (ART). They are at an increased risk of serious non-AIDS co-morbidities and death, and demonstrate enhanced systemic immune activation. In other populations diet has been correlated with markers of systemic inflammation through the Diet Inflammatory Index (DII), but this association has not been studied in persons living with HIV (PLWH). Blood was collected from 28 INR PLWH with a blood CD4+ T cell count <350/μL despite ≥2 years of effective ART. Participants completed a Canadian Diet History Questionnaire, and their responses were used to calculate the DII. Plasma inflammatory markers (IFNγ, TNF, IL-6, sVCAM, D-dimer, sCD14 and CRP) were assayed by ELISA, cellular immune activation (HLA-DR and CD38 on CD4+ and CD8+ T cells) was quantified using flow cytometry, and small bowel permeability assessed by calculation of the urine LacMan ratio after drinking a mix of lactulose and mannitol. Participants were a median age of 57 years, had been on effective ART for 15 years, and the median DII was -1.91 (range of -3.78 to +2.23). No correlation was observed between DII and plasma markers of inflammation, levels of T cell activation, gut permeability, or the biomarker of bacterial translocation sCD14. Self-reported alcohol intake, a potential confounder of the relationship between diet and inflammatory biomarkers, was also not associated with systemic inflammation or gut permeability. Our findings suggest that other mechanisms, rather than diet, are likely to be the major driver of systemic inflammation in INR individuals.
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Affiliation(s)
- Fat Malazogu
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada
| | - Rodney K Rousseau
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Nutrition, Connecting Health Innovations Limited Liability Corporation (LLC), Columbia, SC, United States
| | - Sanja Huibner
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada
| | - Sharon L Walmsley
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Colin M Kovacs
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada.,Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - Erika Benko
- Maple Leaf Medical Clinic, Toronto, ON, Canada
| | | | | | - James R Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Nutrition, Connecting Health Innovations Limited Liability Corporation (LLC), Columbia, SC, United States
| | - Rupert Kaul
- Departments of Medicine and Immunology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
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Rousseau RK, Walmsley SL, Lee T, Rosenes R, Reinhard RJ, Malazogu F, Benko E, Huibner S, Kovacs CM, Singer J, Kim CJ, Kaul R. A randomized, blinded, placebo-controlled trial of De Simone formulation probiotic during HIV-associated suboptimal CD4+ T cell recovery. J Acquir Immune Defic Syndr 2021; 89:199-207. [PMID: 34693932 DOI: 10.1097/qai.0000000000002840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether probiotic supplementation may reduce disease-linked systemic immune activation in people living with HIV with the immunologic non-responder (INR) phenotype. DESIGN Phase 2b, randomized, double-blind, placebo-controlled pilot trial. METHODS HIV-positive individuals with blood CD4+ T cell counts <350/mm3 despite viral suppression were randomized 2:1 to receive De Simone Formulation Probiotic (DSFP; "Visbiome" commercially) or placebo for 48 weeks; target enrolment was 36 patients. The primary endpoint was change in blood CD8+ T cell co-expression of HLA-DR and CD38 ("CD8 activation"). Secondary endpoints included biomarkers of inflammation, immune reconstitution, bacterial translocation, and gut permeability. Adjusted linear regression and linear mixed methods regression evaluated the differences between study arms from baseline to week 48. Study monitoring was done by the CIHR Canadian HIV Trials Network Data Safety Monitoring Committee. RESULTS Nineteen patients received DSFP, while 10 received placebo. One probiotic-arm patient withdrew early. Blood CD8 activation increased 0.82 percentage points (pp) in the probiotic arm (95% confidence interval [CI];-1.23,2.87;) and decreased by 2.06pp in the placebo arm (-4.81,0.70; between arms p=0.097). CD4+ T cell activation (%HLA-DR+) decreased in the placebo arm (-3.79pp [-7.32,-0.26]) but increased in the probiotic arm (1.64 [-0.98,4.26]; between arms p=0.018). No differences were observed in plasma or urine biomarkers of inflammation or microbial translocation. CONCLUSIONS Blood immune activation markers in INR individuals on effective ART were not reduced by supplementation with DSFP; CD4+ T cell activation may have been increased.
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Affiliation(s)
- Rodney K Rousseau
- University of Toronto, Departments of Immunology, Medicine, and Internal Medicine, Toronto, Canada University Health Network, Toronto General Hospital Immunodeficiency Clinic, Toronto, Canada Toronto General Hospital Research Institute, Toronto, Canada CIHR Canadian HIV Trials Network, Vancouver, Canada Centre for Health Evaluation & Outcomes Sciences, Vancouver, Canada Community Health Advocate and Consultant (Independent), Toronto, Canada Public/Global Health Consultant (Independent), San Francisco, USA Maple Leaf Medical Clinic, Toronto, Canada
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Schumacher HR, Reinhard RJ, Wetzler WH. The frustum sign. N Engl J Med 1968; 279:384-5. [PMID: 5662174 DOI: 10.1056/nejm196808152790714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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