Abstract
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. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024605151.