Hepatitis B vaccine: a seven-year study of adherence to the immunization guidelines and efficacy in HIV-1-positive adults

Division of Infectious Diseases, University of Florida Health Science Center, Jacksonville, Florida 32206, USA.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases (Impact Factor: 1.86). 09/2008; 12(6):e77-83. DOI: 10.1016/j.ijid.2008.05.1226
Source: PubMed


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 on Immunization Practices (ACIP) guidelines for hepatitis B vaccination in persons infected with HIV.
This was a seven-year retrospective, cross-sectional analysis of HBV vaccination practices 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.
Of the 1601 charts reviewed, 717 persons were eligible for vaccination against hepatitis B. 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 hepatitis B.
Failure to implement these guidelines represents a missed opportunity to prevent disease. In our study, HIV viral load was better than CD4 count as a predictor of response 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.

Full-text preview

Available from:
  • Source
    • "Liver-related mortality rates of patients with both HBV and HIV infections show a 10-15 fold increase compared with those with only one of these infections. Also, it has been observed that HIV infected patients who have previously been infected with HBV were more likely to develop chronic disease (4, 5) which can result in; cirrhosis, hepatic failure and development of hepatocellular carcinoma (3, 6). Therefore, prevention of hepatitis B in HIV infected patients plays an important role in improving the quality and quantity of their lives. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Human immunodeficiency virus (HIV) infected patients are also frequently exposed to the hepatitis B virus (HBV), due to the common routes of transmission, therefore, prevention of hepatitis B results in decreased complications of the disease. Since the immune response of HIV patients to hepatitis B vaccination is less robust than that found in healthy individuals, this study aimed to evaluate the effect of a levamisole adjuvant on increasing the immune response. In this study, 89 HIV infected patients, without a history of HBV infection or vaccination, were randomly allocated into experimental (44 patients) and control (45 patients) groups. HBV vaccination was performed using the Hepavax-Gene TF vaccine, 40 μg three times at intervals of; zero, one, and three months. Levamisole 50 mg twice a day or a placebo, was administered to the experimental and control groups, respectively, for a period of six days before to six days after the vaccination. Immune response was evaluated by measuring hepatitis B surface antibodies (HBsAb) concurrently with the second and third vaccine administration, and at one and three months at the conclusion of the vaccination program. The immune response following the threevaccinations was higher in those who were receiving levamisole compared with the controls (90% vs. 65.38%) (P = 0.05). Furthermore, the immune response and the mean antibody titer following the repeated vaccination in the experimental group showed a higher increase than in the control group. The immune response and the mean titer of antibody were not associated with; age, sex, body mass index, history of smoking and/or intravenous drug use in either of the groups. However, regarding CD4+ cells more than 200 cell/mm3, mean antibody production significantly increased in both groups. Using levamisole with the hepatitis B vaccination can increase the immune response and antibody titer mean in HIV infected patients. Since these patients have a more complete response with CD4+ cells more than 200 cell/mm3, vaccination and effective adjuvants seem to be most beneficial when CD4+ cells are greater than 200 cell/mm3, in HIV infected patients.
    Full-text · Article · Sep 2012 · Hepatitis Monthly
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This free PDF was downloaded from:
    Preview · Article · Oct 2010
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A SPUDT structure employing λ/4 and wider electrodes is introduced. The design and its variants exploit the significant difference between the reflectivity of short-circuited λ/4 electrodes and that of floating wide electrodes on 128° LiNbO<sub>3</sub>. The SAW devices operating at 2.45 GHz have critical dimensions of about 0.4 μm, accessible for standard optical lithography. When matched, the fabricated SPUDT filters exhibit minimum insertion losses of 5.5-7.9 dB together with 3 dB pass-bands of 95-102 MHz.
    Full-text · Conference Paper · Nov 2003
Show more