title: CD4/CD8 ratio as a predictor of the response to HBV vaccination in HIV-positive patients: A prospective cohort study.
abstract: BACKGROUND
  Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share transmission mechanisms and thus coinfection is frequent. Active immunization against HBV is essential in HIV patients. Reports using standard and reinforced HBV vaccination schedules vary widely in seroconversion rates depending on the characteristics of the included patients. Regional data concerning HBV vaccination in HIV patients are scarce. We aim to determine the serological response to HBV vaccination using standard schedule in HIV-positive patients and to evaluate characteristics that predict seroconversion.
  
  
  METHODS
  We performed a single centre prospective study of HBV vaccination with standard schedule in HIV-positive patients. Adults with negative markers of HBV infection were included between November 2012 and December 2014. Anti-HBs titres were measured 4-8 weeks after completion of vaccination schedule. Clinical, laboratory values and HIV characteristics were analyzed to determine their association with seroconversion and adherence to the HBV vaccination schedule.
  
  
  RESULTS
  The study included 245 HIV-positive patients, 68.9% were male and the mean age was 42.1 years. A total of 80.7% of the patients had undetectable HIV viral loads, 86.1% had CD4 counts >200, and 94.7% were on HAART. The response to vaccination was positive in 62% (95% CI, 56-68%) and mean anti-HBs titres of 646 IU/ml. 85.5% of the responders had anti-HBs titres >100 IU/ml. An age less than 45 years, no tobacco use and a CD4/CD8 ratio >0.4 were associated with seroconversion in multivariate analysis. The seroconversion rates were 86% in the subgroup of patients who met these criteria. A total of 97.9% of the study population completed the vaccination schedule.
  
  
  CONCLUSIONS
  The CD4/CD8 ratio was the primary factor associated with positive serological conversion in the multivariate analysis. The seroconversion rates were higher in a selected group of patients who were particularly suitable for the use of the standard HBV vaccination schedule.
authors.affiliation: Unidad de Hepatología, Hospital Gustavo Fricke, Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fuster
authors.affiliation: Unidad de Hepatología, Hospital Gustavo Fricke, Chile; Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile; Servicio de Medicina Interna, Hospital Naval Almirante Nef, Chile. Electronic address: jivargasd@icloud.com.
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Vargas
authors.affiliation: Servicio de Medicina Interna, Hospital Naval Almirante Nef, Chile; Escuela de Medicina, Universidad de Valparaíso, Chile.
authors.forename: Daniela
authors.initials: D
authors.lastname: Jensen
authors.affiliation: Unidad de Hepatología, Hospital Gustavo Fricke, Chile.
authors.forename: Valeska
authors.initials: V
authors.lastname: Sarmiento
authors.affiliation: Escuela de Medicina, Universidad Andrés Bello, Chile.
authors.forename: Pedro
authors.initials: P
authors.lastname: Acuña
authors.affiliation: Escuela de Medicina, Universidad de Valparaíso, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Peirano
authors.affiliation: Escuela de Medicina, Universidad Del Desarrollo, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fuster
authors.affiliation: Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Arab
authors.affiliation: Departamento de Salud Pública, Escuela de Medicina, Universidad de Valparaíso, Chile; Área de Investigación y Estudios Clínicos, Clínica Ciudad del Mar, Chile.
authors.forename: Felipe
authors.initials: F
authors.lastname: Martínez
mesh_terms: D000328:Adult; D000917:Antibody Formation; D016516:CD4-CD8 Ratio; D005260:Female; D015658:HIV Infections / Q000276:immunology; D006679:HIV Seropositivity; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069078:Seroconversion
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines
keywords: CD4/CD8 ratio; HBV vaccination; Hepatitis B virus; Human immunodeficiency virus