On COVID-19 Protection and HIV Remission: Recaps from CROI 2022

Headshot of Katie Willingham and logos for The Well Project and CROI.

By Katie Willingham

The world's leading HIV science meeting took place virtually yet again in February 2022, and three of The Well Project's Community Advisory Board members were in attendance. Read on for one community author's take on key studies from the Conference on Retroviruses and Opportunistic Infections (CROI 2022) – and check out all The Well Project's coverage of this exciting conference.

Third Person – and First Woman – to Reach HIV Remission

To me, this is the biggest news to come out of CROI this year. Unfortunately, though, it still only helps if you need a stem cell transplant for another disease, in addition to other factors.

Until recently, HIV cure had only been reported in two men who had undergone adult stem cell transplantation. Now it has been reported that a multiracial woman from the US is presently in HIV remission without HIV drugs and has been for more than a year, following a cord blood stem cell transplant to treat her for acute myeloid leukemia (AML). This HUGE news was presented as a late-breaking abstract at CROI 2022 by Yvonne Bryson, MD, of the University of California Los Angeles. The presentation was entitled "HIV-1 Remission with CCR5∆32∆32 Haplo-Cord Transplant in a US Woman: IMPAACT P1107."

This middle-aged woman of mixed race developed high-risk AML while on HIV drugs four years after her HIV diagnosis. She underwent a procedure known as reduced intensity haplo-cord stem cell transplantation, and achieved AML remission. She stopped taking HIV drugs 37 months after her transplant and has remained aviremic (unable to find HIV in her body on ultrasensitive tests).

This is the THIRD known case of HIV remission in the world, the first known case of a woman or a person of mixed race, with haplo-cord stem cell transplantation. The people to reach remission before have been white men, and with a different kind of procedure, so these results could mean a more diverse group could be considered for this approach to cure their HIV. To me, this is the biggest news to come out of CROI this year. Unfortunately, though, it still only helps if you need a stem cell transplant for another disease, in addition to other factors, which is why this approach will not be possible for most people living with HIV.

More on this study from our partner organizations:

POZ Magazine:

TheBody/TheBodyPRO:

In COVID-19 Transmissibility, All is Not Equal

Public health benefits of vaccination may have been underestimated, as COVID vaccines not only protect individuals from acquiring COVID, but also appear to protect against transmission of the virus that causes it.

We know that "breakthrough infections" happen worldwide in people who are vaccinated for COVID, or have had a prior case of COVID, but are people with breakthrough cases just as likely to transmit to others?

Laith J. Abu-Raddad, PhD, MSc, of Weill Cornell Medicine-Qatar explored these concerns in the session "Infectiousness of Breakthrough Infections After Vaccination and Natural Infection." Using Qatar's national databases, effects of vaccination and of prior infection on SARS-CoV-2 (the virus that causes COVID) infectiousness were investigated over a 17-month period in 2020 and 2021, among people with similar traits who represent:

  • first-time (primary) infections in unvaccinated individuals
  • reinfections in unvaccinated individuals
  • Pfizer-BioNTech vaccine breakthrough infections
  • Moderna vaccine breakthrough infections

There appears to be a "hierarchy" in infectiousness of SARS-CoV-2 infections, where primary COVID cases in people who are not vaccinated are most apt to transmit the virus, followed by Pfizer breakthrough cases, Moderna breakthrough cases, and finally new cases in unvaccinated people who have already had COVID previously. This hierarchy of infectiousness is the mirror image of the hierarchy of effectiveness against future cases of COVID, so it correlates strongly with strength of immunity.

Public health benefits of vaccination may have been underestimated, as COVID vaccines not only protect individuals from acquiring COVID, but also appear to protect against transmission of the virus that causes it.

What I understand of this is that being unvaccinated is as dangerous and deadly as being vaccinated is safe and life-saving. The science has been tested and examined six ways to Sunday (no, literally – with six cohorts). I think the science is clear enough that even I can understand it as a non-scientist. I don't understand why rational, educated people would have a problem trusting the science of COVID vaccines.

COVID-19 Vaccine Boosters Work!

The amount of neutralizing antibodies (antibodies that block infection) in individuals with those first two COVID vaccine doses decreased over time, but can be restored by a third booster dose. That protective activity also worked against variants of the virus, including the Delta and Omicron variants.

Two years later and despite having several vaccines available, the COVID-19 pandemic (caused by a coronavirus known as SARS-CoV-2) remains hard to control. Progress in that area is complicated by the emergence of COVID variants that are antibody resistant, meaning they are more likely to slip past whatever protection your body has (from being vaccinated, or from having had COVID before). The abstract "SARS-CoV-2 Antibody Responses in Individuals Following mRNA Booster Vaccination" was presented by Frauke Muecksch, PhD, of The Rockefeller University. The researchers reported on immune system responses of people who had not had COVID before and received two doses of the Moderna or Pfizer-BioNTech vaccines against COVID – both mRNA vaccines – and were boosted with a third vaccine dose thereafter.

The results were that the amount of neutralizing antibodies (antibodies that block infection) in individuals with those first two vaccine doses decreased over time, but can be restored by a third booster dose. That protective activity also worked against variants of the virus, including the Delta and Omicron variants. Boosting vaccinated individuals also increases other aspects of the immune system's response to COVID. Further, monoclonal antibodies (antibodies made in a lab to act like your body's antibodies) generated by cells that experienced a third vaccine dose have greater ability to adapt to foreign viruses, and increased neutralizing activity when compared to antibodies generated after the second dose.

These results suggest that boosting vaccinated individuals with mRNA vaccines provides dramatically increased and broadened plasma neutralizing activity. This happens because of antibody evolution and the resulting production of powerful, broadly active neutralizing antibodies.

I got all of this great information from the presentation abstract. Booster shots have been very effective; I've had mine and I'm glad of it. This study shows how effective they are. What a great presentation!

More from The Well Project on the Conference on Retroviruses and Opportunistic Infections (CROI 2022)

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