title: Hepatitis B vaccination and risk of hepatitis B infection in HIV-infected individuals.
abstract: OBJECTIVE
  To assess the association of hepatitis B virus (HBV) vaccination with risk of HBV infection among HIV-infected patients and HBV infection risk factors among vaccinees.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Participants enrolled from 1986 through 2004, unvaccinated and serologically negative for HBV infection at the time of HIV diagnosis, were followed longitudinally through 2007 for the occurrence of HBV infection. Risk factors for HBV infection were evaluated using time to event methods, including Kaplan-Meier survival curves and Cox proportional hazards models.
  
  
  RESULTS
  During 11 632 person-years of follow-up, the rate of HBV infection was 2.01 (95% CI 1.75-2.27)/100 person-years. Receipt of at least one dose of vaccine was not associated with reduced risk of HBV (unadjusted hazard ratio 0.86, 95% CI 0.7-1.1; adjusted hazard ratio 1.08, 95% CI 0.8-1.4). Receipt of three or more doses of vaccine was also not associated with reduced risk (hazard ratio 0.96; 95% CI 0.56-1.64). Among 409 vaccinees with HBsAb less than 10 IU/l, 46 (11.2%) developed HBV infection compared with 11 of 217 (5.1%) vaccinees with HBsAb > or =10 IU/l (hazard ratio 0.51; 95% CI 0.3-1.0). In participants with initial HBsAb less than 10 IU/l, 16 of 46 (35%) infections were chronic, compared with none of 11 in those with initial HBsAb at least 10 IU/l (P = 0.02).
  
  
  CONCLUSIONS
  Overall, HBV vaccination was not associated with reduced risk of HBV infection in our cohort of HIV-infected individuals. However, the small subset of vaccinees with a positive vaccine response may have had reduced HBV infection risk, including chronic disease. Improvements in vaccine delivery and immunogenicity are needed to increase HBV vaccine effectiveness in HIV-infected patients.
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA. mlandrum@idcrp.org
authors.forename: Michael L
authors.initials: ML
authors.lastname: Landrum
authors.forename: Katherine Huppler
authors.initials: KH
authors.lastname: Hullsiek
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.forename: Amy C
authors.initials: AC
authors.lastname: Weintrob
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.forename: R Vincent
authors.initials: RV
authors.lastname: Barthel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: O'Connell
authors.forename: Ann
authors.initials: A
authors.lastname: Fieberg
authors.forename: Helen M
authors.initials: HM
authors.lastname: Chun
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Marconi
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dolan
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology* / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006515:Hepatitis B virus; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012367:RNA, Viral; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D012367:RNA, Viral