SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Viral Immunology
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1668576
Immunogenicity and Safety of the Booster COVID-19 Vaccine Among People With HIV: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1the Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China
- 2Yunnan University of Chinese Medicine, Kunming, China
- 3Kunming University, Kunming, China
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Background: Human immunodeficiency virus (HIV) and COVID-19 continue to pose significant global public health challenges. Although vaccination is essential for preventing COVID-19 in people with HIV (PWH), evidence on the immunogenicity and safety of booster doses remains limited. This systematic review aimed to assess the immunogenicity and safety of COVID-19 booster vaccination in PWH. Methods: We conducted a comprehensive literature search in PubMed, EMBASE, and the Cochrane Library. Eligible studies included PWH who had received three or more doses of a COVID-19 vaccine. Results: Across 54 included studies, 4,685 of 5,229 PWH achieved seroconversion following a third or subsequent COVID-19 vaccine dose—an improvement over rates observed after the primary vaccine series. In 23 studies comparing 2,284 PWH with 1,813 healthy controls (HC), no significant differences in seroconversion rates were found (p ≥ 0.05). Among PWH, 22 studies reported significantly higher seroconversion rates in individuals with CD4+ T cell counts >200 cells/mm³ compared to those with counts <200 cells/mm³. Booster vaccination enhanced CD4+ T cell responses to levels comparable to HC, although CD8+ T cell responses remained markedly lower. Five studies reported adverse events following booster doses, none of which were classified as serious. Conclusion: COVID-19 booster vaccination is effective in enhancing immune protection and reducing severe disease in PWH. Optimal vaccine dosing is especially important in individuals with low CD4+ T cell counts. Tailoring booster strategies may improve seroconversion and overall immune response in this population.
Keywords: COVID-19, Booster vaccines, HIV, Immunogenicity, CD4+ T cell, seroconversion
Received: 18 Jul 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Chen, Wan, Chen, Mo, Ju, Deng, Li and Qin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dongdong Qin, Yunnan University of Chinese Medicine, Kunming, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.