Factors associated with seroconversion after standard dose hepatitis B vaccination and high-dose revaccination among HIV-infected patients.
BACKGROUND
Patients with HIV-infection often respond poorly to vaccination. We sought to determine rates of seroconversion among HIV-infected patients receiving the hepatitis B vaccine and for non-responders who received high-dose revaccination.


METHODS
A single-center retrospective chart review was performed. Patients received either a series of Engerix-B (20 mcg) or Twinrix (standard dose vaccine [SDV]). A subset of non-responders received a higher 40 mcg dose series of Engerix-B (high-dose revaccination [HDR]).


RESULTS
215 patients received SDV with an overall response rate of 46.5%. Among the 115 non-responders, 30 received HDR with an overall response rate of 66.7%. Factors associated with response to SDV included younger age (odds ratio [OR]/1 year=0.97, P=.03), higher CD4 at first dose (OR/100 CD4=1.13, P=.02), and receipt of Twinrix versus Engerix-B (OR=2.3, P=.003). Higher CD4 at first dose was also associated with response to HDR (OR/100 CD4=2.0, P=.02). All factors remained independently associated with response to SDV and HDR on multivariable analysis.


CONCLUSIONS
HDR appears to be a viable strategy to achieve seroconversion among HIV-infected patients who fail to respond to SDV. Higher CD4 at vaccination, younger age, and receipt of Twinrix were independently associated with SDV seroconversion.
Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, Ann Arbor, Michigan 48109-5378, USA.
Natasha N
NN
Pettit
Daryl D
DD
DePestel
Preeti N
PN
Malani
James
J
Riddell
D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D022362:Hepatitis A Vaccines / Q000276:immunology; D006509:Hepatitis B / Q000517:prevention & control* / Q000821:virology*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017778:Vaccines, Combined / Q000276:immunology; D055815:Young Adult
C075654:Engerix-B; D022362:Hepatitis A Vaccines; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D017778:Vaccines, Combined; C433226:twinrix