Antiretroviral therapy interferes with pseudovirus neutralization assays while Gag-specific T-cells influence mRNA vaccine outcomes in HIV patients

People living with HIV infection (PLWH) often have attenuated responses to infections and vaccination. This study aimed to better understand how HIV-associated inflammation and chronic T-cell activation influenced the immune responses to mRNA vaccination or neutralization assay analyses. PLWH on ART or healthy donor controls were analyzed using systems serology and viral T-cell phenotyping to Spike or HIV-1 Gag peptide stimulation after primary mRNA COVID-19 vaccination. Neutralization assays using a lentiviral pseudovirus construct were compromised by the presence of integrase strand transfer inhibitor (INSTI) drugs in plasma from HIV + subjects taking certain ART. This combination of lentiviral pseudovirus reporter assays and INSTIs led to false positive neutralization results. Spike-specific IgG1, IgG3, IgA1, IgA2, and antibody-dependent cellular phagocytosis (ADCP) were altered post-vaccination in PLWH compared to controls. Network and multivariate analyses revealed post-vaccination outcomes were strongly correlated to CD4 immunodeficiency and Gag-specific T-cells, including effector CD8 T-cells and Th1 CD4 T-cells. Given the growing use of pseudovirus neutralization assays for serological evaluation and mRNA technology in novel vaccines that could be recommended for PLWH Pseudovirus neutralization assays need to be carefully selected to prevent ART drugs in patient samples from impacting results. Spike-specific antibody and CD4 T-cell phenotypes are influenced by both CD4 immunodeficiency and Gag-specific T-cell effector populations. This work has clinical relevance beyond COVID, with future considerations of pseudovirus assay evaluations and mRNA vaccine design for chronically infected hosts.