Abstract
BackgroundCo-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is not infrequent as both share same route of exposure. The risk of developing chronic hepatitis B virus is 6%, in general population but can reach 10–20% in HBV/HIV co-infected patients. When compared to general population, the response rate to HBV vaccine in HIV-infected patients is diminished, so previous studies have tried to improve this response using variety of schedules, doses and co-administration of immunomodulators. The purpose of this study was to evaluate two doses of recombinant HBV vaccine (10 or 40 μg), IM at 0, 1 and 6 months. Vaccination response was measured 30–50 days after last dose; titers of >9.9 IU/L were considered positive.ResultsSeventy-nine patients were included, 48 patients (60.7%) serconverted. Thirty-nine patients (49.3%) received 10 μg vaccine dose, 24 patients (61.5%) seroconverted. Forty patients (50.7%) received 40 μg vaccine dose, 24 (60%) seroconverted. There were no differences between two doses. A statistically significant higher seroconversion rate was found for patients with CD4 cell counts at vaccination ≥ 200 cel/mm3 (33 of 38 patients, 86.8%), compared with those with CD4 < 200 cel/mm3 (15 of 41, 36.6%), [OR 11.44, 95% IC 3.67–35.59, p = 0.003], there were no differences between two vaccine doses. Using the logistic regression model, CD4 count <200 cel/mm3 were significantly associated with non serologic response (p = 0.003). None other variables such as gender, age, risk exposure for HIV, viral load, type or duration of HAART or AIDS-defining illness, were asociated with seroconversion.ConclusionIn this study, an increase dose of HBV vaccine did not show to increase the rate of response in HIV infected subjects. The only significant findings associated to the response rate was that a CD4 count ≥ 200 cel/mm3, we suggest this threshold at which HIV patients should be vaccinated.
Highlights
Co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is not infrequent as both share same route of exposure
We evaluated HIV viral load and CD4 counts at the time of vaccination
We conducted a double blind, randomized, controlled trial using two different concentrations of HBV vaccine 10 or 40 μgs (Recombivax, HB, Merck, Sharp &Dohme, USA), in two groups of HIV-infected patients stratified by CD4 count at time of vaccination (< 200 or ≥ 200 cel/mm3) attending an HIV/AIDS Clinic at the Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán and at the Instituto Nacional de Cancerología in Mexico City
Summary
Co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is not infrequent as both share same route of exposure. The risk of developing chronic hepatitis B virus is 6%, in general population but can reach 10–20% in HBV/HIV co-infected patients. When compared to general population, the response rate to HBV vaccine in HIV-infected patients is diminished, so previous studies have tried to improve this response using variety of schedules, doses and co-administration of immunomodulators. When compared to general population, the response rate to HBV vaccine in HIV-infected patients, is diminished (40–60% vs 60–80%) [10,13]. This lower response is related with CD4 count less than 500 cel/mm, and has been found with other antigens like influenza or pneumococcal vaccines [14,15]
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