Is the Johnson and Johnson COVID vaccine safe for those at risk of HIV?

March 5, 2021 11:03 AM

Is the Johnson and Johnson COVID vaccine safe for those at risk of HIV exposure? Back in October 2020 there was an article published in The Lancet highlighting a possible risk of increased susceptibility to HIV from adenovirus-5 vaccines like the Chinese and Russian Covid vaccines. The Johnson & Johnson vaccine is derived from adenovirus-26. Is there a reason to be concerned?

The concern about risk comes from field experience. A 2007 HIV vaccine trial got derailed because they discovered that their Ad5 vaccine was actually causing some men to be more susceptible to HIV infection, in particular if they'd previously been exposed to adenovirus. The conclusion was that there was a risk Ad5 vaccines could create a population more at risk for HIV infection.

Fast forward to 2020 and Johnson & Johnson has moved forward with adenovirus vaccines for several diseases; Covid, HIV, and others. But I haven't seen anything that says this concern raised in the Lancet article has been addressed. Has it?

One complicating factor; the J&J Covid vaccine is based on adenovirus-26, not Ad5. I have no idea whether the HIV effect seen from Ad5 would also apply to Ad26 or not. (The Russian and Chinese vaccines are Ad5 vaccines.)

This December 2020 note says that the risk shouldn't be considered too serious because it's unlikely many people were previously exposed to the adenovirus being used for the vaccine.

This article in Poz magazine addresses the Ad5 concern, but then writes it off for now because their audience at the time was only likely to get an mRNA vaccine, not an adenovirus vaccine. That's no longer the case though.

PS: I'm 100% enthusiastic about Covid vaccines! I also have read enough to convince me the J&J vaccine is good for preventing serious Covid illness just like the mRNA vaccines (despite the confusing statistics on efficacy). My only concern is this specific interaction with HIV exposure. I will get a vaccine regardless, but I'm wondering if I should insist on one not derived from adenovirus

posted by Nelson to Science & Nature (6 answers total)

It looks like different types of CD4 T cells are more vulnerable to HIV infection than others, including Ad5-specific cells, though it suggests there is not much evidence so far that other Ad vectors increase vulnerability in those CD4 T cells:

Different from Ad5 vectors, immunization of human subjects with a rare adenovirus serotype vector, Ad26, did not cause an increase in numbers or activation status of CD4 T cells in gut mucosa [71], suggesting that the mucosal homing potential, and possibly the HIV susceptibility as well, of Ad5-specific CD4 T cells may not extend to other Ad vectors.

This paper from 2018 suggests there are studies of Ad26- and Ad35-specific susceptability in progress. There's a study referenced here that appears to be measuring susceptability of Ad26-specific CD4 cells to HIV infection, which might be worth following up on.
posted by They sucked his brains out! at 11:44 AM on March 5, 2021 [2 favorites]

I think your optimal options depend a lot on what the vaccination situation is like where you are. I'm in the UK where the rollout is going well but you don't generally get an actual choice of options and being vaccinated outside the NHS is illegal. Most common vaccine used appears to be Astra Zeneca though, with Pfizer next. So if you were here I'd suggest that you get vaccinated on schedule with whatever they have. But the options open to you are probably different.
posted by plonkee at 12:08 PM on March 5, 2021

J&J has intentionally recruited people living with HIV in their vaccine trials, so we should soon have HIV-specific data from that trial. It's certainly safe for PLWHIV. The HIV org where I work is telling all of the people we serve to get whichever of the vaccines they have access to first.
posted by gingerbeer at 1:28 PM on March 5, 2021 [5 favorites]

Interestingly J&J (or rather Janssen, part of J&J) is also developing a HIV vaccine using the Ad26 platform. One trial is done enrolling and the other is still recruiting. Results for the first trial are not expected until 2022, but neither trial has stopped early due to increased risk of HIV in the vaccine arm, which was what happened in the Ad5 HIV vaccine trial you mentioned. So, that's something.
posted by esoterrica at 1:43 PM on March 5, 2021 [2 favorites]

Response by poster: Thanks for all the answers so far. I also consulted an expert who has been involved in Ad26 HIV vaccine testing who said that Ad26 was significantly different from Ad5 and thus the concern from the Ad5 trial did not carry over to the J&J vaccine. Unfortunately I didn't ask for permission to reference them, so this citation won't be terribly useful to anyone else. But FWIW, the fact J&J is developing an HIV vaccine based on Ad26 is a strong indicator there's no a priori reason to think Ad26 is particularly problematic for HIV susceptibility.

For me, any theoretical concern I had about the J&J Ad26 vaccine has been answered. I am curious about all the folks getting Ad5 vaccines made in China or Russia though. I imagine in a few years we'll have data on HIV susceptibility from those vaccinations.
posted by Nelson at 2:54 PM on March 5, 2021 [2 favorites]

The Janssen COVID-19 vaccine is authorized for use under an Emergency Use Authorization (EUA) for active immunization against the COVID-19 Vaccine. There is no such risk to any person who has HIV and no guidelines regarding vaccination for HIV positive person have been released. Only those people who have had a severe allergic reaction to any ingredient of this vaccine should avoid getting vaccinated.
posted by chocolatenights at 7:21 AM on March 19, 2021