title: Hepatitis B vaccination in HIV-infected youth: a randomized trial of three regimens.
abstract: BACKGROUND
  HIV-infected youth are at risk of hepatitis B infection and should be vaccinated. Previous reports suggest reduced response to standard hepatitis B vaccine regimens.
  
  
  METHODS
  HIV-infected youth, aged 12 to younger than 25 years, were randomly assigned to one of three treatment arms: Arm 1: Engerix B, 20 μg HBsAg; Arm 2: Engerix B (GlaxoSmithKline, Rixensart, Belgium), 40 μg; and Arm 3: Twinrix (GlaxoSmithKline, Rixensart, Belgium), 20 μg HBsAg combined with 720 ELU hepatitis A antigen. Vaccines were administered at Weeks 0, 4, and 24.
  
  
  RESULTS
  Characteristics of evaluable patients (n = 336) at entry were similar in the study arms. At enrollment, median CD4+ T-cell count was 460 cells/mm3 (interquartile range, 305-668); 13% were less than 200 cells/mm3. Among Engerix B, 20-μg recipients, 60.4% responded to vaccine (HBsAb 10 IU/mL or greater at Week 28). Improved vaccine response was seen in recipients of Engerix B, 40 μg (73.2% versus Arm 1, P = 0.04) and Twinrix (75.4% versus Arm 1, P = 0.02). In multivariate analysis, only baseline CD4+ T-cell count and study arm were independent predictors of vaccine response.
  
  
  CONCLUSIONS
  In HIV-infected youth, a three-dose vaccination regimen with Engerix B, 40 μg, or Twinrix and higher baseline CD4+ T-cell counts were independently associated with improved vaccine response.
authors.affiliation: Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. pat.flynn@stjude.org
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flynn
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.forename: Bret
authors.initials: B
authors.lastname: Rudy
authors.forename: Craig M
authors.initials: CM
authors.lastname: Wilson
authors.forename: Bill
authors.initials: B
authors.lastname: Kapogiannis
authors.forename: Carol
authors.initials: C
authors.lastname: Worrell
authors.forename: James
authors.initials: J
authors.lastname: Bethel
authors.forename: Dina
authors.initials: D
authors.lastname: Monte
authors.forename: Kelly
authors.initials: K
authors.lastname: Bojan
mesh_terms: D000293:Adolescent; D001530:Belgium; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006801:Humans; D007117:Immunization, Secondary / Q000379:methods; D008297:Male; D014611:Vaccination / Q000379:methods*; D017778:Vaccines, Combined / Q000008:administration & dosage / Q000276:immunology; D055815:Young Adult
chemical_list: C075654:Engerix-B; D022362:Hepatitis A Vaccines; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D017778:Vaccines, Combined; C433226:twinrix