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: 3.62). 12/2008; 27(1):17-22. DOI: 10.1016/j.vaccine.2008.10.040
Source: PubMed


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.

Download full-text


Available from: Mario Cruciani, Feb 09, 2016
  • Source
    • "Besides, a study in the Netherlands showed HBV revaccination with double dose of vaccine intramusculary at 0, 1, and 2 months was effective in 50.7% of 144 HIV-infected nonresponders.[19] Another study by Cruciani et al.,[22] showed response rate of 60% after primary vaccination with double dose of HBV vaccine (40 µg or 2 mL at 0, 1, and 2 months) and higher response rate (89.2%) after 1-3 booster doses in HIV-infected patients. In a recently published study, HIV patients received four doses (40 µg) of HBV vaccine for primary vaccination showed high seroconversion rate 82% versus standard schedule 65%.[14] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Hepatitis B virus (HBV) vaccination is recommended for all human immunodeficiency virus (HIV)-infected patients without HBV immunity. However, serological response to standard HBV vaccination is frequently suboptimal in this population and the appropriate strategy for revaccination of HIV-infected nonresponders remained controversial. We aimed to determine the serological response to one booster dose of HBV vaccine given by intradermal (ID) or intramuscular (IM) route in HIV-positive nonresponders to standard HBV vaccination. Materials and Methods: In this study, 42 HIV-infected nonresponders were enrolled. We randomized them to receive either 10 μg (0.5 mL) for ID (20 cases) or 20 μg (1 mL) for IM (22 cases) administration of HBV vaccine as a one booster dose. After 1 month, anti-HBs titer was checked in all cases. A protective antibody response (seroconversion) defined as an anti-HBs titer ≥10 IU/L. Results: Seroconversion was observed in 47.6% of subjects after 1 ID dose. A total of 30% showed antibody titers above 100 IU/L. Except one case, all responders had CD4+ >200 cells/mm3. Mean anti-HBs titer was 146.5 ± 246 IU/L. After the one IM booster dose, seroconversion was observed in 50% of cases. A total of 36.3% of subjects had anti-HBs ≥100 IU/L. All responders had CD4+ >200 cells/mm3, except one case. Mean anti-HBs titer was 416.4 ± 765.6 IU/L. Responders showed significantly higher CD4+ cell counts, in comparison to nonresponders (P < 0.001). Conclusions: One booster dose administered IM or ID to HIV-infected nonresponders resulted in similar rates of seroconversion, overall response rate 50%. However, higher anti-HBs titers observed more frequently in IM group.
    Full-text · Article · Jul 2014 · Perspectives in clinical research
  • Source
    • "Thus, if the study patients in the intervention and control groups were selected from HIV infected patients with CD4 counts of more than 200 cell/mm3, it is possible that the intervention with levamisole would have had a significant impact on HBsAb production. Similarly in a study by Cruciani et al. on the immune response to higher doses and more frequent times of HBV vaccination in HIV infected patients, they excluded the patients with CD4 counts less than 200 cell/mm3 and their study showed that the patients with higher CD4 counts have better responses to higher doses and more frequent hepatitis B vaccination (20). Also in the study by Sasaki et al. the effect of granulocyte-monocyte colony-stimulating factor as the adjuvant to hepatitis B vaccine was evaluated in HIV infected patients, the patients with CD4 counts less than 350 cell/mm3 were excluded and thus a statistically significant difference between CD4 count and antibody production was not observed in the studied patients (10). "
    [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
    • "57.6% of double-dose HBV rescue vaccine responders were noted to have persistence of protective anti-HBs titer at one-year follow-up. Our findings are consistent with a previous study in which a high serologic response rate with double-dose HBV vaccination was observed, however, 63% of the responders had persistence of protective anti-HBs titer at 12 months.14 Also results of our study correspond with the results of earlier study by Cooper et al.,15 in which 89.5% of HIV-infected patients who received double-dose HBV vaccination developed protective anti-HBs titer, and persistence of seroprotective anti-HBs titer was 60% at 24 months of follow-up. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the durability of protective hepatitis B surface antibody (anti-HBs) titers in HIV-infected patients who responded to double-dose hepatitis B virus (HBV) rescue vaccination. A retrospective chart review was performed for HIV-infected patients who received the double-dose HBV rescue vaccination at 0-, 1-, and 2-month intervals after they had failed conventional HBV vaccination series. A protective antibody response was defined as an anti-HBs titer ≥10 mIU/mL. Of 54 HIV-infected patients who received a double-dose HBV rescue vaccination, 44 patients (81.5%) had a positive response and achieved protective anti-HB titers. Of the 44 patients who developed protective anti-HB titers, 33 patients received an evaluation of their anti-HB titers 12 months later. Of the 33 patients, 19 (57.6%) had persistent protective anti-HB titers (persistent responders, PR), and 14 patients (42.4%) lost their protective anti-HB titers (nonpersistent responders, NPR). There were significantly more patients who had an undetectable HIV viral load (<50 copies/mL) at baseline and follow-up in the PR group (11/19, 57.9%) than in the NPR group (3/14, 21.4%, p=0.036). Logistic regression analysis showed that an undetectable HIV viral load at baseline and follow-up (odds ratio, 12.973; 95% confidence interval, 1.189 to 141.515; p=0.036) was associated with PR. Protective anti-HB titers may decrease over time after successful double-dose HBV rescue vaccination in HIV-infected patients. HIV viral load suppression could improve the persistence of anti-HB titers.
    Full-text · Article · Jan 2012 · Gut and liver
Show more