Efficacy of Hepatitis B Immunization in HIV-Infected Patients on Hemodialysis (HD)

Abstract

Patients on HD are at a high risk of hepatitis B infection. Therefore hepatitis B vaccination is recommended for all HD patients, although compared with adults with normal immune status, the protective antibody response is lower and ranges from 34–88%. We hypothesized that HIV infected patients on HD are likely to have even lower antibody responses to hepatitis B vaccination. We therefore reviewed the immunization history of 16 HIV‐infected dialysis patients who received chronic maintenance HD at our dialysis units. The mean age of the patients was 43 ± 11 (mean ± SD). Of the 16 patients the majority were black males (13). The mean CD 4 count of these patients was 261 ± 206 (mean ± SD, range: 18–668 cells/μL). The mean viral load was 96727 ± 184084 (range 50–650846 copies/ml). Six patients had undetectable plasma viral loads. Of the 16 patients, 10 had protective antibodies (HBs Ab ≥ 10 mIU/ml). Of these 10 patients, 3 had positive Hepatitis core antibody suggesting previous viral exposure, another 3 were negative for HBcAb and in the remaining 4 HBcAb was unavailable. Five of the 10 patients with protective antibody received vaccination after starting dialysis. Pearson product moment correlation showed negative correlation of HBsAb with viral load, r = − 0.45, p value = 0.07. No correlation was found between CD4 count and response to vaccination. We conclude that HIV‐infected HD patients develop protective antibodies at a rate similar to HIV‐negative HD patients.