Increasing the number of hepatitis B vaccine injections augments anti-HBs response rate in HIV-infected patients. Effects on HIV-1 viral load.
Preventing hepatitis B by vaccination is essential in HIV-infected patients (higher progression rate of HBV infection to chronicity, lower rate of serum HBe Ag loss). However, it has been shown a decreased anti-HBs response in these individuals after a standard vaccination (3 doses of 20 micrograms). Thus, we tested the hypothesis that doubling the number of hepatitis B vaccine injections might increase anti-HBs response rate. HIV-infected patients with CD4 > 200/microliter, who were on stable antiretroviral treatment, as well as seronegative for HBV markers, and who have never been vaccinated against HBV, were given 3 intramuscular injections of Genhevac B 20 micrograms at 1 month intervals. Initial non responders were given 3 additional monthly injections. Anti-HBs titer was followed. We also evaluated the effects on HIV-1 viral load. Twenty patients with a median CD4 cell count of 470/microliter were enrolled. The response rate after three 20 micrograms injections was 55% (11/20), lower in individuals with CD4 between 200 and 500/microliter (4/12 = 33.3%), compared to patients with CD4 above 500/microliter (7/8 = 87.5%, P = 0.02). Among 9 initial non-responders, only 2 did not respond to 3 additional doses; thus, the overall response rate was 90% (18/20). Geometric mean titers of anti-HBs were 133 IU/l and 77.5 IU/l, after 3 and 6 Genhevac doses, respectively (P = 0.38). One year later, only 10/17 (58.8%) patients had protective anti-HBs. Five patients experienced a significant viral load increase, transient in 3 cases. These preliminary results suggest that doubling the number of hepatitis B vaccinations in HIV-infected patients might significantly improve anti-HBs response rate; however, close monitoring of anti-HBs is necessary because of its short-lived persistence. The effects on HIV-1 viral load are limited.
Rey
D
D
CISIH, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France. david.rey@chru-strasbourg.fr
Krantz
V
V
Partisani
M
M
Schmitt
M P
MP
Meyer
P
P
Libbrecht
E
E
Wendling
M J
MJ
Vetter
D
D
Nicolle
M
M
Kempf-Durepaire
G
G
Lang
J M
JM
D000328:Adult; D000818:Animals; D018791:CD4 Lymphocyte Count; D016466:CHO Cells; D006224:Cricetinae; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000276:immunology* / Q000821:virology*; D015497:HIV-1; D006509:Hepatitis B / Q000097:blood / Q000517:prevention & control / Q000821:virology; D006510:Hepatitis B Antibodies / Q000096:biosynthesis / Q000097:blood / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load
C075656:GenHevac B Pasteur; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines