Article

Serologic response to hepatitis B vaccine with high dose and increasing number of injections in HIV infected adult patients

Center of Preventive Medicine, HIV Outpatient Clinic, V. Germania, 20-37135 Verona, Italy.
Vaccine (Impact Factor: 3.49). 12/2008; 27(1):17-22. DOI: 10.1016/j.vaccine.2008.10.040
Source: PubMed

ABSTRACT Sixty-five HIV-infected patients received high-dose (40mug), short interval HBV vaccine. In non-responders to the initial immunization, 1-3 boosters were administered. Rate of response was 60.0% after primary vaccination, and 89.2% after boosters. However, 12 and 24 months after the last vaccination, only 63% and 32.7% of the responders, respectively, had persistence of protective anti-HBs titers (> or =10 IU/L). The results of logistic regression show that gender, CD4 count, and HIV viral load were significant predictors of vaccination outcome. This study suggests that in HIV-infected patients with relatively high CD4 count, response to high dose of HBV vaccine is suboptimal. Rate of response may be increased by vaccine boosts, but antibody titers are significantly lower in non-responders than in responders to primary vaccination. Since persistence of anti-HBs titers appears significantly related to antibody titers after the immunization procedure, monitoring of anti-HBs, particularly in patients with low level of protective antibody titers after primary vaccination or boosters, seems more than justified.

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Available from: Mario Cruciani, Jul 28, 2015
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    • "Vaccines based on recombinant HBV surface antigen (HBsAg) oVer a safe and eVective strategy for preventing HBV infection, as anti-HBsAg antibody (Ab) concentrations can exceed the minimum protective level of 10 mIU/mL for up to 95% of healthy recipients. Nonetheless, lack of eYcacy can be a problem to vaccine recipients with compromised or impaired immune system (Collier et al. 1988; Zuin et al. 1992), which has prompted the search for further improvements through (a) increasing the amount of antigen given in each injection (Cornejo-Juarez et al. 2006; Cruciani et al. 2009; de Vries-Sluijs et al. 2008; Fonseca et al. 2005; Pasricha et al. 2006), (b) adding an extra (boosting) dose when the standard three-dose regimen fails to induce protective Ab response (Cruciani et al. 2009; Rey et al. 2000), and (c) using immunoregulatory cytokine or unmethylated CpG oligonucleotide as an adjuvant in one of the priming doses (Cooper et al. 2008; Sasaki et al. 2003). Suboptimal Ab response to full-dose HBV vaccination was common in adolescents and youth enrolled by the Reaching for Excellence in Adolescent Care and Health (REACH) study supported by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) (Wang et al. 2004; Wilson et al. 2001). "
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    ABSTRACT: To confirm and refine associations of human leukocyte antigen (HLA) genotypes with variable antibody (Ab) responses to hepatitis B vaccination, we have analyzed 255 HIV-1 seropositive (HIV+) youth and 80 HIV-1 seronegatives (HIV−) enrolled into prospective studies. In univariate analyses that focused on HLA-DRB1, -DQA1, and -DQB1 alleles and haplotypes, the DRB1*03 allele group and DRB1*0701 were negatively associated with the responder phenotype (serum Ab concentration ≥ 10 mIU/mL) (P = 0.026 and 0.043, respectively). Collectively, DRB1*03 and DRB1*0701 were found in 42 (53.8%) out of 78 non-responders (serum Ab <10 mIU/mL), 65 (40.6%) out of 160 medium responders (serum Ab 10–1,000 mIU/mL), and 27 (27.8%) out of 97 high responders (serum Ab >1,000 mIU/mL) (P < 0.001 for trend). Meanwhile, DRB1*08 was positively associated with the responder phenotype (P = 0.010), mostly due to DRB1*0804 (P = 0.008). These immunogenetic relationships were all independent of non-genetic factors, including HIV-1 infection status and immunodeficiency. Alternative analyses confined to HIV+ youth or Hispanic youth led to similar findings. In contrast, analyses of more than 80 non-coding, single nucleotide polymorphisms within and beyond the three HLA class II genes revealed no clear associations. Overall, several HLA-DRB1 alleles were major predictors of differential Ab responses to hepatitis B vaccination in youth, suggesting that T-helper cell-dependent pathways mediated through HLA class II antigen presentation are critical to effective immune response to recombinant vaccines. Electronic supplementary material The online version of this article (doi:10.1007/s00439-009-0720-z) contains supplementary material, which is available to authorized users.
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    • "Vaccines based on recombinant HBV surface antigen (HBsAg) oVer a safe and eVective strategy for preventing HBV infection, as anti-HBsAg antibody (Ab) concentrations can exceed the minimum protective level of 10 mIU/mL for up to 95% of healthy recipients. Nonetheless, lack of eYcacy can be a problem to vaccine recipients with compromised or impaired immune system (Collier et al. 1988; Zuin et al. 1992), which has prompted the search for further improvements through (a) increasing the amount of antigen given in each injection (Cornejo-Juarez et al. 2006; Cruciani et al. 2009; de Vries-Sluijs et al. 2008; Fonseca et al. 2005; Pasricha et al. 2006), (b) adding an extra (boosting) dose when the standard three-dose regimen fails to induce protective Ab response (Cruciani et al. 2009; Rey et al. 2000), and (c) using immunoregulatory cytokine or unmethylated CpG oligonucleotide as an adjuvant in one of the priming doses (Cooper et al. 2008; Sasaki et al. 2003). Suboptimal Ab response to full-dose HBV vaccination was common in adolescents and youth enrolled by the Reaching for Excellence in Adolescent Care and Health (REACH) study supported by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) (Wang et al. 2004; Wilson et al. 2001). "
    Human Genetics 01/2009; 126(5):685-696. · 4.52 Impact Factor
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