title: Hepatitis B vaccine responses in a large U.S. military cohort of HIV-infected individuals: another benefit of HAART in those with preserved CD4 count.
abstract: The influence of highly active antiretroviral therapy (HAART) upon hepatitis B virus (HBV) vaccine responses in HIV-infected individuals is unclear. After classification of vaccinees as non-responders (HBsAb <10IU/L) or responders (HBsAb >or=10IU/L) in our HIV cohort, multivariate logistic regression was used to assess factors associated with subsequent vaccine response. Of 626 participants vaccinated from 1988 to 2005, 217 (35%) were vaccine responders. Receipt of >or=3 doses of vaccine (OR 1.83, 95% CI 1.24-2.70), higher CD4 count at vaccination (OR 1.09, 95% CI 1.05-1.13 per 50 cells/microl increase), and use of HAART (OR 2.37, 95% CI 1.56-3.62) were all associated with increased likelihood of developing a response. However, only 49% of those on HAART at last vaccination responded, and 62% of those on HAART, with CD4 count >or=350, and HIV RNA <400 copies/mL responded. Compared to those on HAART with CD4 count >or=350, those not on HAART with CD4 count >or=350 had significantly reduced odds of developing a vaccine response (OR 0.47, 95% CI 0.30-0.70). While HAART use concurrent with HBV immunization was associated with increased probability of responding to the vaccine, the response rate was low for those on HAART. These data provide additional evidence of HAART benefits, even in those with higher CD4 counts, but also highlight the need for improving HBV vaccine immunogenicity.
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA. mlandrum@idcrp.org
authors.forename: Michael L
authors.initials: ML
authors.lastname: Landrum
authors.forename: Katherine
authors.initials: K
authors.lastname: Huppler 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: Sheila
authors.initials: S
authors.lastname: Peel
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D008297:Male; D008889:Military Personnel; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines