Calculated Globulin as Immune Response Predictor?

Hepatitis B test
Hepatitis B test
Higher calculated globulin levels in the setting of HIV viral suppression and high CD4 counts may serve as surrogate markers for immune dysfunction.

NEW ORLEANS — Higher calculated globulin levels in the setting of HIV viral suppression and high CD4 cell counts may be able to serve as surrogate markers for immune dysfunction and could help provide insight into those patients who may have a weaker response to hepatitis B vaccination, according to research presented at IDWeek 2016.

Thomas A. O’Bryan, MD, from the Infectious Disease Clinical Research Program, of the Uniformed Services University of the Health Sciences, and colleagues used data from the US Military HIV Natural History Study and noted 159 active duty or beneficiaries in the Department of Defense who had HIV infection and who received the hepatitis B vaccine.

Dr O’Bryan noted that vaccine responders were typically younger, and that there was a small but statistically significantly difference in calculated globulin levels between vaccine responders and nonresponders.

“Those with the lowest globulin levels had a response rate of 82% but as we increase across the quartiles, [which ranged from 1.7-26 g/dl to 3.3-5.0 g/dl], it goes down to 57%, so there may be a linear relationship,” he said. The overall HBV response rate was around 72%.

Discussing future directions, Dr O’Bryan noted that validated correlations of calculated globulin with measured immunoglobulin levels and markers of B-cell activation in viremically-suppressed patients are needed.

“We also need to develop treatment strategies to improve immune dysfunction after achieving viral suppression,” he added.

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O’Bryan T, Olsen C, Rahmen S, et al. Calculated Globulin Levels Predict Hepatitis B Vaccine Response in HIV-Infected Persons with Viremic Suppression and High CD4 Cell Count. Presented at: IDWeek 2016. New Orleans, LA. October 26-30, 2016. Oral abstract 852.