Hepatitis B vaccine: a seven-year study of adherence
to the immunization guidelines and efficacy in
Christina L. Bailey, Vanessa Smith, Michael Sands*
Division of Infectious Diseases, University of Florida Health Science Center, Jacksonville, Florida 32206, USA
Received 14 February 2008; received in revised form 6 May 2008; accepted 19 May 2008
Corresponding Editor: Mark Holodniy, California, USA
Since the adoption of universal vaccination of newborns and
adolescents in 1991, overall new hepatitis B infection rates
primarily in high-risk adults. In the Centers for Disease
International Journal of Infectious Diseases (2008) 12, e77—e83
Hepatitis B vaccination;
Hepatitis B vaccination
Hepatitis B vaccine
Background: Vaccination against hepatitis B virus (HBV) has been recommended for all high-risk
adults since 1982. Since the advent of highly active antiretroviral therapy, few studies have
examined adherence to the Infectious Diseases Society of America (IDSA) and Advisory Committee
Methods: This was a seven-year retrospective, cross-sectional analysis of HBV vaccination prac-
tices in HIV-1-positive adults treated in an urban ambulatory care center. Compliance with
screening, hepatitis B vaccination recommendations, and response to vaccination were assessed.
Results: Ofthe 1601chartsreviewed, 717 persons wereeligible forvaccinationagainst hepatitisB.
Of these patients, 503 received at least one dose of vaccine, but only 356 patients completed the
three-dose series. Vaccine response was associated with CD4 count (p = 0.006) and viral load
(p = 0.001) at the time of the first dose.However, development of hepatitis B surface antibody was
seen at all CD4 counts and viral loads. The multivariate analysis showed only the HIV viral load was
predictive of immunologic response. Twenty of the vaccine-eligible patients who did not receive
vaccination were infected with HBV during the study period. No vaccinated persons contracted
Conclusion: Failure to implement these guidelines represents a missed opportunity to prevent
disease.Inour study, HIV viral load was betterthan CD4 count asa predictor ofresponse to the HBV
vaccination. However, neither low CD4 count nor high HIV viral load should be used as justification
to delay vaccination of high-risk persons.
# 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
E-mail address: email@example.com (M. Sands).
1201-9712/$32.00 # 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
26. Neau D, Winnock M, Galperine T, Jouvencel AC, Castera L,
Legrand E, et al. Isolated antibodies against the core antigen
of hepatitis B virus in HIV-infected patients. HIV Med
27. Alhababi F, Sallam TA, Tong CY. The significance of ‘anti-HBc
only’in the clinicalvirology
28. ShireNJ,RousterSD, RajicicN,ShermanKE.Occult hepatitisBin
HIV-infected patients. J Acquir Immune Defic Syndr 2004;36:
29. Ural O, Findik D. The response of isolated anti-HBc positive
subjectsto recombinant hepatitis
30. Lok AS, Lai CL, Wu PC. Prevalence of isolated antibody to
hepatitis B core antigen in an area endemic for hepatitis B virus
infection: implications in hepatitis B vaccination programs.
31. Kahn J. Preventing hepatitis A and hepatitis B virus infections
among men who have sex with men. Clin Infect Dis
B vaccine.J Infect
Hepatitis B vaccine in HIV-1-positive adultse83