Response to hepatitis B vaccination in a primary care setting: influence of HIV infection, CD4+ lymphocyte count and vaccination schedule

Abstract

Factors affecting the response to hepatitis B vaccination in a primary care setting were examined by means of a review of case notes of patients attending 22 sexually transmissible disease services. Where not available from the notes, presence of antibody to hepatitis B surface antigen (anti-HBs) was determined by testing available stored serum. One hundred and ninety-five patients completed a course of 3 injections and had an anti-HBs assay performed. The highest response rate (anti-HBs > or = 10 IU/L) was found in human immunodeficiency virus (HIV)-negative heterosexual women (16 of 17, 94.1%) followed by HIV-negative heterosexual men (11 of 12, 91.7%); HIV-negative homosexual men (105 of 120, 87.5%); and HIV-positive homosexual men (6 of 14, 42.9%). (For HIV-positive vs HIV-negative homosexual men, P = 0.0003). Eleven of 14 (78.6%) homosexual men of unknown HIV status responded to vaccination. There was a trend to lower CD4+ lymphocyte counts among HIV-infected patients who responded to hepatitis B vaccination (mean 482 cells/cm2) when compared to those that did not respond (632 cells) but this difference was not statistically significant (P = 0.330). Neither the type of vaccine (recombinant, plasma-derived or mixed) nor the length of vaccination course (mean 6.2 months; range 2 to 18) affected response. This study confirmed that vaccination against hepatitis B is much less effective in HIV-infected homosexual men and marginally less effective for HIV-negative homosexual men, though the mechanism for this reduced response is uncertain. Reassuringly vaccine response was not affected by common variables in primary care settings such as vaccine type or delays in the vaccine schedule.

Immune Response to Standard Hepatitis B Vaccination in HIV-Infected Patients

“…The association of HBV seroprotection rates and CD4 counts is controversial. Some studies have shown higher response rates associated with higher CD4 counts while others have obtained contrary data [15,16,18,19,[22][23][24][25]. Our study showed that CD4 counts had no influence on the immune response to HBV vaccination and accords with Wilson [16] and Overton [22] studies.…”

“…Prior studies of the immune responses to HBV vaccine in HIV infected patients have indicated varying response rates from 0% to 87%. [15,16,18,19,[22][23][24][25]. Cornejo-Juárez et al [26] found 60.7% response rate in HIVinfected patients vaccinated with HBV recombinant vaccine.…”

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…The 0, 1 and 6 months and the 0, 1 and 2 months, with an additional dose at 12 months schedules have both been shown to be efficacious in HIV-infected patients [18,19]. There are very few data on the 0, 7-10 and 21 days, with an additional dose at 12 months schedule in HIV-positive patients, although one small study showed a 51% response after the first three doses and an 88% response after six doses [20].…”

Dialyzing a Patient with Human Immunodeficiency Virus Infection: What a Nephrologist Needs to Know

“…Immunization for hepatitis B in HIV-infected CKD patients is more important because not only does HBV infection occur more frequently with HIV infection for behavioral reasons, but also because the pre-HAART studies suggested that these patients are more likely to develop chronic infection [105]. However, several reports have suggested that antibody response to hepatitis vaccination is impaired in HIV-infected patients [106, 107, 108]. Although hepatitis vaccination may increase plasma viral load, the effect is minimal and transient and is unlikely to be of clinical relevance [109, 110].…”