Immunogenicity and safety of the booster COVID-19 vaccine among people with HIV: a systematic review and meta-analysis

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. Method(s): 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. Result(s): 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(s): 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 Copyright © 2025 Chen, Wan, Chen, Mo, Ju, Deng, Li and Qin.