Impact of CD4 T cell counts on the immunogenicity and safety of the recombinant zoster vaccine in people living with HIV.
Min-Kyung Kim, Hyeon Jae Jo, Chan Mi Lee et al.
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In 30 seconds
This non-randomized clinical trial assessed immunogenicity and safety of two doses of recombinant zoster vaccine (RZV) in virologically suppressed people living with HIV (PLWH) receiving antiretroviral therapy, stratified by CD4 count, and in participants without HIV. Sixty PLWH and 10 participants without HIV were analyzed. After dose two, all groups had a 100% humoral vaccine response rate, while cell-mediated response rates were 33.3% in the low-CD4 group, 50.0% in the high-CD4 group, and 80.0% in participants without HIV (P = 0.041). Reactogenicity was comparable across groups.
Key findings
- After dose two, humoral vaccine response rates were 100% in all groups.
- Cell-mediated response rates were 33.3% with CD4 <300 cells/μL, 50.0% with CD4 ≥300 cells/μL, and 80.0% in participants without HIV (P = 0.041).
- Anti-gE antibody titers increased after each dose, with no between-group differences.
- Reactogenicity profiles were comparable across groups.
Why it matters
The findings distinguish antibody responses from cell-mediated responses after RZV in PLWH. Robust humoral responses were observed across CD4 strata, but cell-mediated response rates were lower in PLWH than in participants without HIV. This provides clinically relevant immunogenicity and safety data for a population at increased risk of herpes zoster, while not establishing vaccine effectiveness against clinical disease.
What to keep in mind
The trial was non-randomized, and the comparison group without HIV included only 10 participants. The abstract reports immunogenicity and reactogenicity, not prevention of herpes zoster.