the relationship between immunological response of covid-19 vaccines and hiv status according to cd4 count and viral load in the pediatric population

While most children typically exhibit milder covid-19 symptoms, compromised immunity from hiv may result in suboptimal responses to sars-cov-2 vaccines, heightening the risk of severe complications. the indonesian government policy recommends the covid-19 vaccination program for children aged 12-17 years; however, no specific details were provided for those with hiv infection. to elucidate the interaction between hiv status with covid-19 vaccines immunological response. a retrospective, cross-sectional study was conducted at dr. soetomo general hospital, indonesia, from january to may 2024. multiple generalized linear regression model was employed to identify predictors of covid-19-specific igg levels. among 44 hiv-infected children aged 3-17 years, 86.4% demonstrated reactive covid-19-specific igg responses (median: 517.8). in children aged >5 years, higher igg levels were independently associated with female sex (b 828.37; p= 0.047), higher cd4+ count (b 1.744; p < 0.001), and undetectable viral load (b –1412.20; p < 0.001). bivariate analysis showed higher igg levels in children receiving ≥1 vaccine dose (median igg: first-dose=2134.5; second-dose=1176) compared to unvaccinated (150.15). children aged ≤5 years (n=6) were excluded from regression modeling due to insufficient sample size for age-stratified analysis and differing immunological markers (cd4% instead of absolute cd4 count). immune status, particularly cd4+ count and hiv viral load, significantly influenced humoral responses to covid-19 vaccines in hiv-infected children, especially among those aged over 5 years. these findings emphasize the need for individualized vaccination strategies in immunocompromised pediatric populations, highlighting the role of viral suppression and immune monitoring in optimizing vaccine-induced protection.