title: Long-term response rates of successful hepatitis B vaccination in HIV-infected patients.
abstract: BACKGROUND
  Data on long-term response rates after successful primary hepatitis B (HBV) vaccination in HIV-infected patients are scarce.
  
  
  OBJECTIVE
  To evaluate the durability of an effective anti-HBs titer up to 5 years after primary vaccination in a cohort of 155 HIV-infected adults.
  
  
  METHODS
  From a previous multicenter HBV vaccination trial we selected patients with an anti-HBs titer of ≥10 IU/l 28 weeks after the first vaccination. The anti-HBs titer was measured in annually stored plasma samples up to 5 years after vaccination. Patients with decreasing anti-HBs titers <10 IU/I were defined as transient responders (TR) and with persistent anti-HBs titers ≥10 IU/I as long-term responders (LTR^).
  
  
  RESULTS
  We included 155 patients, 87 were TR and 68 LTR. Mean age, percentage of female participants and duration of HAART use at primary vaccination were similar in LTR and TR. Anti-HBs level after primary vaccination was the strongest predictor for the durability of anti-HBs. Anti-HBs >100-1000 IU/I and >1000 resulted in an OR 8.3, 95% CI 3.38-20.16; p<0.0001 and OR 75.6, 95% CI 13.41-426.45; p<0.0001 versus anti-HBs titer of 10-100 IU/I after primary vaccination respectively. The mean time to loss of an effective anti-HBs titer was 2.0, 3.7 and 4.4 years respectively, for patients with an anti-HBs titer of 10-100 IU/I, >100-1000 IU/I and >1000 IU/I at primary vaccination. An undetectable HIV-RNA load and use of HAART during vaccination and at follow-up were, though not significantly, associated a higher long-term persistence of an effective antibody titer.
  
  
  CONCLUSIONS
  The durability of an effective anti-HBs level appears to be significantly related to the height of the antibody titers after the primary immunization procedure. Schedules to improve the vaccination response in HIV-infected patients therefore seem to be justified. Whether a HBV booster is indicated remains to be elucidated.
authors.affiliation: Department of Internal Medicine, Section Infectious Diseases, Erasmus MC - Central Location, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. v.baptistalopes@erasmusmc.nl
authors.forename: Vania Baptista
authors.initials: VB
authors.lastname: Lopes
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hassing
authors.forename: Theodora E M S
authors.initials: TE
authors.lastname: de Vries-Sluijs
authors.forename: Abdel
authors.initials: A
authors.lastname: El Barzouhi
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.forename: Martin
authors.initials: M
authors.lastname: Schutten
authors.forename: Robert A
authors.initials: RA
authors.lastname: de Man
authors.forename: Marchina E
authors.initials: ME
authors.lastname: van der Ende
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / 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; D007156:Immunologic Memory; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines