title: Vaccination against hepatitis B with 4-double doses increases response rates and antibodies titers in HIV-infected adults.
abstract: BACKGROUND
  Antibody responses to standard regimens of hepatitis B (HBV) vaccination are lower in HIV-infected subjects and the best hepatitis B vaccine schedule in this population is not known.
  
  
  OBJECTIVE
  To assess the immunogenicity and to evaluate predictors of serologic response of a modified regimen of a HBV recombinant vaccine in a cohort of HIV-infected subjects.
  
  
  METHODS
  HIV-infected subjects received 4 doses (40 μg) of a recombinant HBV vaccine at 0, 1, 2 and 6 months. Demographic information as well as CD4 cell count and plasma viral load were assessed at baseline. Protective and strong responses were defined as an anti-HBs titer ≥10 mIU/mL and ≥100 mIU/mL, respectively and were evaluated one month after the third and the fourth doses.
  
  
  RESULTS
  163 HIV-infected individuals were evaluated 67 (40%) were male and median age was 37 years. Median CD4 cell count was 385 cells/mm(3) and 113 (70%) had undetectable HIV-1 viral load. Protective antibody response was observed in 83 and 91% and a strong antibody response was observed in 62 and 80% of the subjects after 3 and 4 doses, respectively. In a multivariate logistic model undetectable HIV-1 viral load and higher CD4 cell counts were independent predictors of a strong antibody response after 4 doses. Patients with undetectable HIV viral load were almost 3 times more likely to have anti-HBs titers above 100 mIU/mL than those with detectable viral load.
  
  
  CONCLUSIONS
  A 4-double-dose regimen of a recombinant HBV vaccine increased response rates and determined higher antibody titers which may translate in prolonged protection against HBV. Inclusion of a fourth dose of HBV vaccine for HIV-infected subjects should be considered in the public health setting.
authors: HUCFF/FM - Universidade Federal do Rio de Janeiro, Brazil. dvpotsch@openlink.com.br
authors: D V
authors: DV
authors: Potsch
authors: L A B
authors: LA
authors: Camacho
authors: S
authors: S
authors: Tuboi
authors: L M
authors: LM
authors: Villar
authors: J C
authors: JC
authors: Miguel
authors: C
authors: C
authors: Ginuíno
authors: E F
authors: EF
authors: Silva
authors: R M M
authors: RM
authors: Mendonça
authors: R B
authors: RB
authors: Moreira
authors: P F
authors: PF
authors: Barroso
mesh_terms: D000328:Adult; D000917:Antibody Formation / Q000276:immunology; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000503:physiopathology* / Q000821:virology; D015497:HIV-1 / Q000276:immunology / Q000472:pathogenicity; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood* / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D014611:Vaccination / Q000379:methods*; D014614:Vaccines, Synthetic / Q000008:administration & dosage; D019562:Viral Load
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic