Antibody response durability following three-dose COVID-19 vaccination in people with HIV receiving suppressive ART

BackgroundLimited data exist regarding longer-term antibody responses following three-dose COVID-19 vaccination, and the impact of a first SARS-CoV-2 infection during this time, in people living with HIV (PLWH) receiving suppressive antiretroviral therapy (ART). We quantified wild-type-(WT), Omicron BA.1- and Omicron BA.5-specific responses up to six months post-third dose in 64 PLWH and 117 controls who remained COVID-19-naive or experienced their first SARS-CoV-2 infection during this time. DesignLongitudinal observational cohort. MethodsWe quantified WT- and Omicron-specific Anti-Spike receptor-binding domain IgG concentrations, ACE2 displacement activities and live virus neutralization at one, three and six months post-third vaccine dose. ResultsThird doses boosted all antibody measures above two-dose levels, but BA.1-specific responses remained significantly lower than WT-specific ones, with BA.5-specific responses lower still. Serum IgG concentrations declined at similar rates in COVID-19-naive PLWH and controls post-third dose (median WT- and BA.1-specific half-lives were between 66-74 days for both groups). Antibody function also declined significantly yet comparably between groups: six months post-third dose, BA.1-specific neutralization was undetectable in >80% of COVID-19 naive PLWH and >90% of controls. Breakthrough SARS-CoV-2 infection boosted antibody concentrations and function significantly above vaccine-induced levels in both PLWH and controls, though BA.5-specific neutralization remained significantly poorer than BA.1 even post-breakthrough. ConclusionsFollowing three-dose COVID-19 vaccination, antibody response durability in PLWH receiving ART is comparable to controls. PLWH also mounted strong responses to breakthrough infection. Due to temporal response declines however, COVID-19-naive individuals, regardless of HIV status, would benefit from a fourth dose within 6 months of their third.

People with HIV receiving suppressive antiretroviral therapy show typical antibody durability after dual COVID-19 vaccination, and strong third dose responses

BackgroundLonger-term humoral responses to two-dose COVID-19 vaccines remain incompletely characterized in people living with HIV (PLWH), as do initial responses to a third dose. MethodsWe measured antibodies against the SARS-CoV-2 spike protein receptor-binding domain, ACE2 displacement and viral neutralization against wild-type and Omicron strains up to six months following two-dose vaccination, and one month following the third dose, in 99 PLWH receiving suppressive antiretroviral therapy, and 152 controls. ResultsThough humoral responses naturally decline following two-dose vaccination, we found no evidence of lower antibody concentrations nor faster rates of antibody decline in PLWH compared to controls after accounting for sociodemographic, health and vaccine-related factors. We also found no evidence of poorer viral neutralization in PLWH after two doses, nor evidence that a low nadir CD4+ T-cell count compromised responses. Post-third-dose humoral responses substantially exceeded post-second-dose levels, though anti-Omicron responses were consistently weaker than against wild-type. Nevertheless, post-third-dose responses in PLWH were comparable to or higher than controls. An mRNA-1273 third dose was the strongest consistent correlate of higher post-third-dose responses. ConclusionPLWH receiving suppressive antiretroviral therapy mount strong antibody responses after two- and three-dose COVID-19 vaccination. Results underscore the immune benefits of third doses in light of Omicron.

Humoral immune responses to COVID-19 vaccination in people living with HIV on suppressive antiretroviral therapy

Humoral responses to COVID-19 vaccines in people living with HIV (PLWH) remain incompletely understood. We measured circulating antibodies against the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein, ACE2 displacement and live viral neutralization activities one month following the first and second COVID-19 vaccine doses in 100 adult PLWH and 152 controls. All PLWH were receiving suppressive antiretroviral therapy, with median CD4+ T-cell counts of 710 (IQR 525-935) cells/mm3. Nadir CD4+ T-cell counts ranged as low as <10 (median 280; IQR 120-490) cells/mm3. After adjustment for sociodemographic, health and vaccine-related variables, HIV infection was significantly associated with 0.2 log10 lower anti-RBD antibody concentrations (p=0.03) and [~]11% lower ACE2 displacement activity (p=0.02), but not lower viral neutralization (p=0.1) after one vaccine dose. Following two doses however, HIV was no longer significantly associated with the magnitude of any response measured. Rather, older age, a higher burden of chronic health conditions, and having received two ChAdOx1 doses (versus a heterologous or dual mRNA vaccine regimen) were independently associated with lower responses. After two vaccine doses, no significant correlation was observed between the most recent or nadir CD4+ T-cell counts and vaccine responses in PLWH. These results suggest that PLWH with well-controlled viral loads on antiretroviral therapy and CD4+ T-cell counts in a healthy range will generally not require a third COVID-19 vaccine dose as part of their initial immunization series, though other factors such as older age, co-morbidities, vaccine regimen type, and durability of vaccine responses will influence when this group may benefit from additional doses. Further studies of PLWH who are not receiving antiretroviral treatment and/or who have low CD4+ T-cell counts are needed.

Relative Ratios of Human Seasonal Coronavirus Antibodies Predict the Efficiency of Cross-Neutralization of SARS-CoV-2 Spike Binding to ACE2

BackgroundAntibodies raised against human seasonal coronaviruses (sCoVs), which are responsible for the common cold, are known to cross-react with SARS-CoV-2 antigens. This prompts questions about their protective role against SARS-CoV-2 infections and COVID-19 severity. However, the relationship between sCoV exposure and SARS-CoV-2 correlates of protection are not clearly identified. MethodsWe performed a cross-sectional analysis of cross-reactivity and cross-neutralization to SARS-CoV-2 antigens (S-RBD, S-trimer, N) using pre-pandemic serum from four different groups: pediatrics and adolescents, persons 21 to 70 years of age, older than 70 years of age, and persons living with HCV or HIV. FindingsAntibody cross-reactivity to SARS-CoV-2 antigens varied between 1.6% and 15.3% depending on the cohort and the isotype-antigen pair analyzed. We also show a range of neutralizing activity (0-45%) in serum that interferes with SARS-CoV-2 spike attachment to ACE2. While the abundance of sCoV antibodies did not directly correlate with neutralization, we show that neutralizing activity is rather dependent on relative ratios of IgGs in sera directed to all four sCoV spike proteins. More specifically, we identified antibodies to NL63 and OC43 as being the most important predictors of neutralization. InterpretationOur data support that exposure to sCoVs triggers antibody responses that influence the efficiency of SARS-CoV-2 spike binding to ACE2, and may also impact COVID-19 disease severity through other latent variables. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSThere is a growing body of evidence showing that within the population there are varying levels of pre-existing immunity to SARS-CoV-2 infection and possibly COVID-19 disease severity. This immunity is believed to be attributable to prior infection by four prevalent seasonal coronaviruses (sCoVs) responsible for the common cold. Pre-existing immunity can be assessed in part by antibodies directed to sCoVs that also cross-react to SARS-CoV-2 antigens. The SARS-CoV-2 spike and, more specifically, the receptor binding domain are the primary targets for neutralizing antibodies. It is unclear if cross-reactive antibodies to SARS-CoV-2 are neutralizing and are also responsible for the broad spectrum of COVID-19 disease severity, from asymptomatic to critical, observed in the infected population. Added-value of this studyHere we carried out a detailed analysis of sCoV prevalence in samples acquired before the pandemic from individuals of various age groups and in people living with HIV and HCV. We then analyzed the frequency of all the different types of antibodies that cross-react to three SARS-CoV-2 antigens. We found a high level of people with cross-reactive antibodies, surprisingly we also detected that some people have antibodies that block the SARS-CoV-2 spike from binding to its human receptor, ACE2. By using machine learning, we were able to accurate predict which individuals can neutralize SARS-CoV-2 spike-ACE2 interactions based on their relative ratios of antibodies against the four sCoVs. Implications of all the available evidenceWe demonstrate that it not absolute levels of sCoVs antibodies that are predictive of neutralization but the relative ratios to all four sCoVs, with NL63 being the most weighted for this prediction. Machine learning also highlighted the existence of latent variables that contribute to the neutralization and that may be related to the type of cellular immune response triggered by the infection to certain sCoVs. This study is one of the first to identify a functional relationship between prior-exposure to sCoV and the establishment of a certain degree of immunity to SARS-CoV-2 by way of a cross-reactive antibody response. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=179 SRC="FIGDIR/small/21260079v3_ufig1.gif" ALT="Figure 1"> View larger version (42K): org.highwire.dtl.DTLVardef@e74392org.highwire.dtl.DTLVardef@1052bd5org.highwire.dtl.DTLVardef@80d88eorg.highwire.dtl.DTLVardef@10976cb_HPS_FORMAT_FIGEXP M_FIG C_FIG

The effect of Reiki on work-related stress of the registered nurse.

PURPOSE: The Reiki Master Teacher group at a large academic, urban medical center studied the effects of Reiki on work-related stress in Registered Nurse Reiki I class participants. Research suggests that work-related stress is an influential factor in nursing burn out and retention. Reiki, an ancient form of Oriental "energy work" or healing, has been found to decrease stress. METHODS: The Perceived Stress Scale tool was administered prior to the Reiki I class and after three weeks of practicing self-Reiki. FINDINGS: Seventeen participants returned follow-up data. Results indicated that practicing Reiki more often resulted in reduced perceived stress levels. CONCLUSIONS: Data from this small pilot study supports educating nurses about Reiki practice to decrease work-related stress.