RESUMO
Background: A community COVID-19 outbreak caused by the B.1.1.7 SARS-CoV-2 variant occurred in Taiwan in May 2021. High-risk populations such as people living with HIV (PLWH) were recommended to receive two doses of COVID-19 vaccines. While SARS-CoV-2 vaccines have demonstrated promising results in general population, real-world information on the serological responses remains limited among PLWH. Methods: PLWH receiving the first dose of SARS-CoV-2 vaccine from 2020 to 2021 were enrolled. Determinations of anti-SARS-CoV-2 spike IgG titers were performed every one to three months, the third dose of the SARS-CoV-2 vaccine or confirmed SARS-CoV-2 infection. All serum samples were tested for anti-nucleocapsid antibody and those tested positive were excluded from analysis. Results: A total of 1189 PLWH were enrolled: 829 (69.7%) receiving two doses of the AZD1222 vaccine, 232 (19.5%) of the mRNA-1273 vaccine, and 128 (10.8%) of the BNT162b2 vaccine. At all time-points, PLWH receiving two doses of mRNA vaccines had consistently higher antibody levels than those receiving the AZD1222 vaccine (p <0.001 for all time-point comparisons). Factors associated with failure to achieve an anti-spike IgG titer >141 BAU/mL within 12 weeks, included type 2 diabetes mellitus (DM) (adjusted odds ratio [aOR], 2.24; 95% CI, 1.25-4), a CD4 T cell count <200 cells/mm3 upon receipt of the first dose of vaccination (aOR, 3.43; 95% CI, 1.31-9) and two homologous AZD1222 vaccinations (aOR, 16.85; 95%CI, 10.13-28). For those receiving two doses of mRNA vaccines, factors associated with failure to achieve an anti-spike IgG titer >899 BAU/mL within 12 weeks were a CD4 T cell count <200 cells/mm3 on first-dose vaccination (aOR, 3.95; 95% CI, 1.08-14.42) and dual BNT162b2 vaccination (aOR, 4.21; 95% CI, 2.57-6.89). Conclusions: Two doses of homologous mRNA vaccination achieved significantly higher serological responses than vaccination with AZD1222 among PLWH. Those with CD4 T cell counts <200 cells/mm3 and DM had consistently lower serological responses.
RESUMO
Infectious diseases are often stigmatized and criminalized because of the way they are transmitted. An experience providing care to a 37-year-old patient with human immunodeficiency virus (HIV) infection who was admitted to a medical center's quarantine ward in July 2021 due to SARS-CoV-2 infection is described in this article. This patient lived with his mother, who was later diagnosed with COVID-19 as well. He was worried about his mother's health condition and, meanwhile, feared that information about his diseases and person would be exposed by the media. These stressors led to increased feelings of shame and anxiety and to situational low self-esteem. Several interventions were provided, including education regarding the importance of personal hygiene and of maintaining combination antiretroviral therapy (cART) to bolster immune system functions. During the isolation period, the nurses most regularly interacted with the patient directly. Thus, we worked to build the nurse-patient relationship by listening to the patient's worries, guaranteeing his privacy would not be compromised, and guiding him to express his emotions to reduce anxiety and enhance confidence. This experience demonstrated the importance of providing psychological care to COVID-19/HIV co-infected patients. We suggest that the government and media distribute correct and neutral information to destigmatize communicable diseases and to foster a friendlier healthcare environment.