Maya Alkhidir, Kannan Sridharan
Background: People living with human immunodeficiency virus (HIV) (PLWH) remain at increased risk of severe COVID-19 outcomes; however, conflicting evidence exists regarding the seroconversion rates of COVID-19 vaccines in this population. Methods: A systematic review and meta-analysis were conducted on studies reporting seroconversion outcomes following COVID-19 vaccination in PLWH. Results: Forty-four studies (5391 PLWH) were included in the meta-analysis. The overall pooled seroconversion proportion was 93.5%. Bootstrap analysis confirmed robustness (92.8%). Subgroup analyses revealed significantly higher seroconversion rates for mRNA vaccines (98.2%) compared to non-mRNA vaccines (80.5%). CD4 count demonstrated a graded association: <200 cells/mm3 (53.8%), 200-500 cells/mm3 (86.2%), and >500 cells/mm3 (93.5%). Prior COVID-19 infection (99.1% vs. 89.5%) and antiretroviral therapy (ART) status (93.5% vs. 49.6%) were significant determinants. Safety data demonstrated a favorable profile, with predominantly mild-to-moderate local (injection-site pain: 23.8%) and systemic (headache: 12.95%, fatigue: 6.4%) adverse events; serious adverse events were rare and no consistent association with HIV disease progression was observed. Conclusions: COVID-19 vaccination induces high seroconversion rates in PLWH, particularly among those receiving mRNA vaccines, with preserved CD4 counts, on ART, or with prior infection.