Effectiveness of hepatitis A vaccination among people living with HIV in Taiwan: Is one dose enough?

Abstract

Single dose hepatitis A virus (HAV) vaccine had been proven its efficacy in immunocompetent but not immunocompromised hosts. We aim to investigate the effectiveness of one dose versus 2 doses HAV vaccine among people living with HIV (PLHIV). We conducted a 1:1 single center retrospective case-control study for PLHIV in Northern Taiwan. Case patients were those who received single dose HAV vaccine and controls were those who completed standard 2 doses HAV vaccine. Nationwide campaign of single dose HAV vaccine had been practiced for high risk population including PLHIV and those who had newly diagnosed sexually transmitted diseases. During February 2016 and December 2017, 90 cases received single dose HAV vaccine provided while the other 90 age-matched controls received 2 doses vaccine were enrolled. We found more injection drug users (22.22% vs. 1.11%, p<0.0001), more co-infection with viral hepatitis C (28.89% vs. 5.56%, p<0.0001), and history of syphilis infection (56.67% VS 30%, p=0.0003) in single dose group than 2 doses group. Seroconversion rate at one year was significantly higher in 2 doses group (97.78% vs 56.67%, p<0.0001). Among single dose group, people with hepatitis B or C virus co-infection (HBV: p=0.02, aOR: 0.03, 95% CI: 0.002-0.55; HCV: p=0.002, aOR: 0.22, 95% CI: 0.08-0.58) were less likely to achieve seropositivity, while those who had higher CD4 count at baseline and one year, had better response to vaccine. Two doses HAV vaccine is necessary among PLHIV to achieve sustained seroresponse rather than single dose.