The response to double-dose hepatitis B vaccination in patients with HIV

Abstract

Objectives: Prevention of hepatitis B virus (HBV) infection is necessary for patients with human immunodeficiency virus (HIV), since co-infection is associated with increased in mortality. The aim of this study was to investigate response to double-dose HBV vaccine in patients with HIV.

Methods: A total of 149 patients with HIV were retrospectively evaluated. Sixty-eight patients who were HBV seronegative and administered double-dose HBV vaccine were included in the study. According to anti HBs levels, patients were evaluated in three groups: < 10 mIU/mL, 10-100 mIU/mL and ≥ 100 mIU/mL. Age, sex, transmission route, smoking, alcohol-substance abuse, comorbidities, CD4+ T cells counts and HIV viral load were compared in three groups.

Results: The rate of response to HBV vaccination (anti HBs ≥ 10 mIU/mL) was 69.1%. Age was statistically significantly higher in the anti HBs < 100 mIU/mL group than in the anti HBs >100 mIU/mL group. The level of anti HBs was statistically significantly lower in patients with a CD4+ T cell count < 200 cells/μL (< 100 mIU/mL).

Conclusions: The use of high-dose vaccine is a necessity as well as revaccination to improve vaccine immunogenicity in patients with HIV. In our study, low CD4+ T lymphocyte count and older age were found to have a negative effect on vaccine response.

Keywords

• co-infection
• HBV
• HBV vaccination
• HIV
• response

References

1. 1. Pasricha N, Datta U, Chawla Y, Singh S, Arora SK, Sud A, et al. Immune responses in patients with HIV infection after vaccination with recombinant Hepatitis B virus vaccine. BMC Infect Dis 2006; 6:65.
2. 2. Thio CL, Seaberg EC, Skolasky R Jr, Phair J, Visscher B, Munoz A, et al.; Multicenter AIDS Cohort Study. HIV-1, hepatitis B, and risk of liver-related mortality in the Multicenter AIDS Cohort Study (MACS). Lancet 2002;360:1921-6.
3. 3. Overton ET, Sungkanuparph S, Powderly WG, Seyfried W, Groger RK, Aberg JA. Undetectable plasma HIV RNA load predicts success after hepatitis B vaccination in HIV-infected persons. Clin Infect Dis 2005; 41:1045-3.
4. 4. Van Herck K, Van Damme P, Thoelen S, Meheus A. Long-term persistence of antiHBs after vaccination with a recombinant DBA yeast derived hepatitis B vaccine: 8 year results. Vaccine 1998;16:1933-5.
5. 5. European AIDS Clinical Society Treatment Guidelines. Available at Accessed: October 2017.
6. 6. British HIV Association guidelines on the use of vaccines in HIV-positive adults 2015. Available at Accessed: November 2015.
7. 7. İnci A, Fincancı M. [Antibody response to a standard dose of hepatitis B vaccine in HIV-infected patients]. Klimik Journal 2014;27:12-4. [Article in Turkish]
8. 8. Kellerman SE, Hanson DL, McNaghten AD, Fleming PL. Prevalence of chronic hepatitis B and incidence of acute hepatitis B infection in human immunodeficiency virus-infected subjects. J Infect Dis 2003;188:571-7.

9. 9. Kim HN, Harrington RD, Crane HM, Dhanireddy S, Dellit TH, Spach DH. Hepatitis B vaccination in HIV-infected adults: current evidence, recommendations and practical considerations. Int J STD AIDS 2009;20:595-5.
10. 10. Flynn PM, Cunningham CK, Rudy B, Wilson CM, Kapogiannis B, Worrell C, et al. Hepatitis B vaccination in HIV-infected youth: a randomized trial of three regimens. J Acquir Immune Defic Syndr 2011;56:325-7.
11. 11. Colin JF, Cazals-Hatem D, Loriot MA, Martinot-Peignoux M, Pham BN, Auperin A, et al. Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men. Hepatology 1999;29:1306-4.
12. 12. Martin-Carbonero L, Poveda E. Hepatitis B virus and HIV infection. Semin Liver Dis 2012;32:1149.
13. 13. Thio CL. Hepatitis B in the human immunodeficiency virus-infected patient: epidemiology, natural history, and treatment. Semin Liver Dis 2003;23:125-11.
14. 14. Bodsworth N, Cooper D, Donovan B. The influence of HIV-1 infectionon the development of hepatitis B virus carrier state. J Infect Dis 1991;163:1138-2.
15. 15. Gilson RJ, Hawkins AE, Beecham MR, Ross E, Waite J, Briggs M, et al. Interactions between HIV and hepatitis B in homosexual men: effects on the natural history of infection. AIDS 1997;11:597-606.
16. 16. Atalay S, Kış TT, Sönmez U, Köse Ş. Hepatitis B and C sero-prevalence in patients with human immunodeficiency virus/acquired immune deficiency syndrome at tertiary care hospital in Izmir. Viral Hepat J 2018;24:3-6.
17. 17. Hahné SJ, Veldhuijzen IK, Wiessing L, Lim TA, Salminen M, Laar Mv. Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening. BMC Infect Dis 2013;13:181.
18. 18. İ̇nci A, Fincancı M, Soysal F. HIV/HBV co-infected cases. J Clin Anal Med 2015;6:439-3.
19. 19. Wong E, Bodsworth NJ, Slade MA, Mulhall BP, Donovan B. Response to hepatitis B vaccination in a primary care setting: influence of HIV infection, CD4+ lymphocyte count and vaccination schedule. Int J STD AIDS 1996;7:490-4.
20. 20. Jack AD, Hall AJ, Maine N, Mendy M, Whittle HC. What level of hepatitis B antibody is protective? J Infect Dis 1999;179:489-3.
21. 21. Cornejo-Juárez P, Volkow-Fernández P, Escobedo-López K, Vilar-Compte D, Ruiz-Palacios G, Soto-Ramírez LE. Randomized controlled trial of Hepatitis B virus vaccine in HIV-1-infected patients comparing two different doses. AIDS Res Ther 2006;3:9.
22. 22. Tedaldi EM, Baker RK, Moorman AC Wood KC, Fuhrer J, McCabe RE, et al. Hepatitis A and B vaccination practices for ambulatory patients infected with HIV. Clin Infect Dis 2004;38:1478-6.
23. 23. Rey D, Krantz V, Partisani M, Schmitt MP, Meyer P, Libbrecht E, et al. Increasing the number of hepatitis B injections augments antiHBs response rate in HIV infected patients. Effect on viral load. Vaccine 2000;18:1161-5.
24. 24. Fonseca MO, Pang LW, de Paula Cavalheiro N, Barone AA, Heloisa Lopes M. Randomized trial of recombinant hepatitis B vaccine in HIV infected adult patients comparing a standard dose to a double dose. Vaccine 2005;23:2902-8.
25. 25. Hoebe CJ, Vermeiren AP, Dukers-Muijrers NH. Revaccination with Fendrix® or HBVaxPro® results in better response rates than does revaccination with three doses of Engerix-B® in previous nonresponders. Vaccine 2012;30:6734-7.
26. 26. Launay O, van der Vliet D, Rosenberg AR, Michel ML, Piroth L, Rey D, et al. Safety and immunogenicity of 4 intramuscular double doses and 4 intradermal low doses vs Standard hepatitis B vaccine regimen in adults with HIV‐1: a randomized controlled trial. JAMA 2011;305:1432-40.
27. 27. Whitaker JA, Rouphael NG, Edupuganti S, Lai L, Mulligan MJ. Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV‐1. Lancet Infect Dis 2012;12:966-10.
28. 28. Ni JD, Xiong YZ, Wang XJ, Xiu LC. Does increased hepatitis B vaccination dose lead to a better immune response in HIV‐infected patients than standard dose vaccination: a meta analysis. Int J STD AIDS 2013;24:117-5.
29. 29. De Vries‐Sluijs TE, Hansen BE, van Doornum GJ, Springeling T, Evertsz NM, de Man RA, et al. A prospective open study of the efficacy of high‐dose recombinant hepatitis B rechallenge vaccination in HIV infected patients. J Infect Dis 2008;197:292-4.
30. 30. Potsch DV, Oliveira ML, Ginuino C, Miguel JC, Oliveira SA, Silva EF, et al. High rates of serological response to a modified hepatitis B vaccination schedule in HIV-infected adults subjects. Vaccine 2010;28:1447-3.