title: Hepatitis B vaccination uptake and correlates of serologic response among HIV-infected and uninfected men who have sex with men (MSM) in Bangkok, Thailand.
abstract: BACKGROUND
  Vaccination against hepatitis B virus (HBV) is recommended for all HBV-susceptible men who have sex with men (MSM). There is limited information on correlates of immunity to HBV vaccination in this group. We present serologic response rates to hepatitis B vaccine and identify factors associated with impaired response among HIV-uninfected and HIV-infected Thai MSM.
  
  
  METHODS
  HBV-susceptible volunteers were offered hepatitis B vaccination at months zero, one, and six. We measured baseline (pre-vaccination) total serum IgG and IgG subclasses (all participants), baseline CD4 count, and plasma HIV-1 viral load (PVL) (HIV+ participants). HBV serologies were retested at 12 months. Serologic responses were compared between all groups in men receiving three vaccine doses.
  
  
  RESULTS
  511/651 HIV-negative and 64/84 HIV-positive participants completed the three-dose series. Response rates in HIV-uninfected and -infected participants were 90.1% vs. 50.0% (p<0.0001). Median pre-vaccination IgG was higher among non-responders than responders overall (1238.9.0 vs. 1057.0mg/dL, p=0.003) and among HIV-infected participants (1534.0 vs. 1244.5mg/dL, p=0.005), but not significantly among HIV-uninfected participants (1105.5 vs. 1054.3mg/dL, p=0.96). Pre-vaccination IgG1 and IgG3 levels were higher among HIV-positive than HIV-negative participants (median 866.0 vs. 520.3, and 105.8 vs. 83.1mg/dL, respectively, p<0.0001). Among HIV-infected participants, median CD4 count in non-responders was 378 cells/μL vs. 431 cells/μL in responders (p=0.20). Median PVL in non-responders was 64,800 copies/mL vs. 15500 copies/mL in responders (p=0.04). Participants with pre-vaccination plasma IgG >1550 mg/dL and PVL >10,000 copies/mL were almost always non-responsive (p<0.01).
  
  
  CONCLUSIONS
  HIV infection was associated with poor vaccine responses. High plasma viral load, elevated pre-vaccination total serum IgG and elevated pre-vaccination IgG1 are associated with poorer response to vaccination among HIV-infected MSM. In this group, the combination of high PVL and pre-vaccination total IgG is highly predictive of vaccine failure.
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Wannee
authors.initials: W
authors.lastname: Chonwattana
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Boonyos
authors.initials: B
authors.lastname: Raengsakulrach
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Holtz
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Punneeporn
authors.initials: P
authors.lastname: Wasinrapee
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Jaray
authors.initials: J
authors.lastname: Tongtoyai
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Supaporn
authors.initials: S
authors.lastname: Chaikummao
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Sarika
authors.initials: S
authors.lastname: Pattanasin
authors.affiliation: Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: McNicholl
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Thai Red Cross Society AIDS Research Center, Bangkok, Thailand.
authors.forename: Frits
authors.initials: F
authors.lastname: van Griensven
authors.affiliation: Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: vdu7@th.cdc.gov.
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Curlin
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000276:immunology; D015658:HIV Infections / Q000276:immunology*; D006679:HIV Seropositivity; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D018451:Homosexuality, Male; D006801:Humans; D056724:Immunity, Humoral; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D013785:Thailand; D019562:Viral Load; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D007074:Immunoglobulin G
keywords: HBV; HIV; IgG; Plasma viral load; Serologic response; Vaccination