Maraviroc-Containing Combined Antiretroviral Therapy Improves Response to HBV Vaccine

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The effects of MVC-cART on HBV vaccine response may in part be the result of reduction of activated CD4 T cells prior to vaccination.
The effects of MVC-cART on HBV vaccine response may in part be the result of reduction of activated CD4 T cells prior to vaccination.

Maraviroc-containing combined antiretroviral therapy (MVC-cART) may improve the response to hepatitis B virus (HBV) vaccine in HIV-infected patients by reducing activated and proliferating CD4 T cells prior to vaccination, according to a study published in the Journal of Translational Medicine.1

Patients with HIV are at high risk for HBV infection and its related morbidity and mortality; therefore, current guidelines recommend HBV vaccination for all HIV-infected participants who are susceptible to HBV coinfection.2-4 Maraviroc is a CCR5 antagonist that has demonstrated an enhanced response to vaccination,5 and MVC-cART has been associated with a better response to HBV vaccination in subjects under 50 years of age.6

However, the mechanism of this beneficial effect is unknown. Thus, researchers explored the potential effects of MVC-cART in different parameters related to inflammation, T-cell function, and dendritic cell subsets by analyzing baseline samples of 41 HBV-vaccinated, HIV-infected subjects less than 50 years old on MVC-cART.1

They found that these subjects demonstrated increased recent thymic emigrants levels and reduced myeloid-dendritic cell levels. In addition, a longer exposure to MVC-cART was associated with lower frequencies of T-regulatory cells and activated and proliferating CD4 T cells. Furthermore, the frequencies of activated and proliferating CD4 T cells were inversely related to the magnitude of the HBV vaccine response.

The authors concluded that, “the beneficial effect of MVC-cART in the HBV vaccine response in subjects below 50 years old could be mediated at least partially by its reducing effect on the frequencies of activated and proliferating CD4 T cells prior to vaccination.”1

References

  1. Herrero-Fernández I, Rosado-Sánchez I, Genebat M, et al. Improved CD4 T cell profile in HIV-infected subjects on maraviroc-containing therapy is associated with better responsiveness to HBV vaccination [published online August 29, 2018]. J Transl Med. 2018;16:238.
  2. Thio CL. Hepatitis B and human immunodeficiency virus coinfection. Hepatology. 2009;49(5 suppl):S138-S145.
  3. Clifford GM, Rickenbach M, Polesel J, et al. Influence of HIV-related immunodeficiency on the risk of hepatocellular carcinoma. AIDS. 2008;22(16):2135-2141.
  4. Whitaker JA, Rouphael NG, Edupuganti S, Lai L, Mulligan MJ. Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1. Lancet Infect Dis. 2012;12:966-976.
  5. Westrop SJ, Moyle G, Jackson A, Nelson M, Mandalia S, Imami N. CCR5 antagonism impacts vaccination response and immune profile in HIV-1 infection. Mol Med. 2012;18:1240-1248.
  6. Herrero-Fernández I, Pacheco YM, Genebat M, et al. Association between a suppressive combined antiretroviral therapy containing maraviroc and the hepatitis B virus vaccine response. Antimicrob Agents Chemother. 2017;62(1).
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