Association between hepatitis B vaccine antibody response and CD4 reconstitution after initiation of combination antiretroviral therapy in HIV-infected persons.
BACKGROUND
Hepatitis B virus (HBV) vaccine antibody response has been associated with reduced risk of AIDS or death. However, it is unknown whether HBV vaccine responsiveness is associated with improved immune reconstitution during treatment with combination antiretroviral therapy (cART). We evaluated the relationship between HBV vaccine response status and CD4 reconstitution on cART in the U.S Military HIV Natural History Study.


METHODS
Participants with viral load <400 copies/mL within 1 year on initial cART and documented HBV vaccination and surface antibody (anti-HBs) prior to cART were included. Participants were characterized as HBV vaccine responders (anti-HBs ≥10 IU/L) or non-responders (<10 IU/L) and further divided into 2 groups based on vaccine administration before or after HIV diagnosis. Linear mixed regression was used to model CD4 reconstitution during the first year of cART.


RESULTS
Of the 307 and 169 participants vaccinated before or after HIV diagnosis, HBV vaccine response occurred in 288 (94%) and 74 (44%), respectively. For those vaccinated before HIV diagnosis, CD4 counts increased by a median 190 [IQR 99-310] cells/mm(3) for responders and 186 [IQR 116-366] cells/mm(3) for non-responders during the first year (P = 0.684). Participants vaccinated after HIV diagnosis had median increases of 185 [IQR 76-270] and 143 [IQR 47-238] cells/mm(3) for responders and non-responders, respectively (P = 0.134). In contrast to those with CD4 > 350 cells/mm(3) at cART initiation, participants with CD4 < 200 and 200-350 cells/mm(3) had significantly reduced CD4 gains in both groups by longitudinal mixed models, but there was no difference in CD4 recovery according to HBV vaccine seroresponse.


CONCLUSIONS
Although HBV vaccine responsiveness is associated with a reduction in HIV disease progression, HBV vaccine responders do not achieve greater CD4 gains during the first year of cART. Additional clinical markers are needed to predict the magnitude of post-cART immune recovery.
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. kahtonna.c.allen.mil@mail.mil.|Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA. kahtonna.c.allen.mil@mail.mil.
Kahtonna
K
Allen
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. omesner@idrcrp.org.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA. omesner@idrcrp.org.
Octavio
O
Mesner
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. anuradha.ganesan.civ@health.mil.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA. anuradha.ganesan.civ@health.mil.|Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD, USA. anuradha.ganesan.civ@health.mil.
Anuradha
A
Ganesan
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. thomas.a.obryan2.ctr@mail.mil.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA. thomas.a.obryan2.ctr@mail.mil.
Thomas A
TA
O'Bryan
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Robert.Deiss.ctr@med.navy.mil.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA. Robert.Deiss.ctr@med.navy.mil.|Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA, USA. Robert.Deiss.ctr@med.navy.mil.
Robert G
RG
Deiss
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. bagan@idcrp.org.|The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA. bagan@idcrp.org.
Brian K
BK
Agan
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Jason.f.okulicz.mil@mail.mil.|Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, USA. Jason.f.okulicz.mil@mail.mil.
Jason F
JF
Okulicz
D000328:Adult; D000917:Antibody Formation; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; 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; D012698:Serologic Tests; D014481:United States; D019562:Viral Load; D055815:Young Adult
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines