Poor efficacy of intradermal administration of recombinant hepatitis B virus immunization in HIV-infected individuals who fail to respond to intramuscular administration of hepatitis B virus vaccine.
OBJECTIVE
It is recommended that hepatitis B virus (HBV)-susceptible, HIV-infected persons be immunized for HBV. However, 44-76% of HIV-infected persons fail to respond to a standard series of recombinant HBV vaccine. Intradermal (i.d.) administration of HBV vaccine has been effective in nonresponders to intramuscularly administered vaccine among healthcare workers, haemodialysis patients and renal transplant recipients. We evaluated the immunogenicity of HBV vaccine given by the intradermal route in HIV-infected individuals who failed to respond to two series of HBV vaccine given intramuscularly.


METHODS
Recombinant HBV vaccine [10 microg HBV surface antigen (HBsAg)/mL] was administered as 0.25 mL i.d. every 2 weeks for four doses in 12 HIV-infected adults who failed to respond to six doses of HBV vaccine administered by the intramuscular route. Anti-HBs was tested at least 2 weeks following the fourth dose of i.d. administered vaccine, and if the anti-HBs titre was negative or <30 IU/L, a second series of four i.d. doses were administered every 2 weeks. Anti-HBs was measured at least 2 weeks following the second series of i.d. administered HBV vaccine and 6 and 12 months after the last dose.


RESULTS
Protective levels of anti-HBs (>10 IU/L) were achieved in six subjects (50%) after four doses. Administration of four additional i.d. doses to the six nonresponders did not result in any additional seroconverters. Five of the six responders had no detectable anti-HBs at 12 months after the last dose of i.d. administered vaccine.


CONCLUSIONS
The i.d. route of administration of recombinant HBV vaccine does not appear to be immunogenic in HIV-infected adults who fail to respond to six doses of intramuscularly administered vaccine.
Shafran
S D
SD
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. sshafran@ualberta.ca
Mashinter
L D
LD
Lindemulder
A
A
Taylor
G D
GD
Chiu
I
I
D000279:Administration, Cutaneous; D000328:Adult; D005260:Female; D006678:HIV / Q000276:immunology*; D015658:HIV Infections / Q000276:immunology* / Q000821:virology; D006509:Hepatitis B / Q000276:immunology* / Q000517:prevention & control / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014614:Vaccines, Synthetic / Q000008:administration & dosage / Q000276:immunology
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic