Certain characteristics and HIV-related factors may help predict whether certain demographics of people with HIV will have an optimal response to reinforced hepatitis B virus vaccination, according to an article published in Vaccine.

Chronic hepatitis as a result of hepatitis B virus (HBV) infection, represents a major health concern worldwide, causing complications that include the development of cirrhosis and hepatocellular carcinoma. In 2015, 887,000 deaths were attributed to HBV infection, which affects more than 250 million people worldwide despite the availability of the effective recombinant hepatitis B vaccine. Further, people with HIV have an elevated prevalence of HBV infection because of the shared route of transmission and therefore a higher rate of chronicity and increased liver-related morbidity and mortality.

However, the rate of seroprotection achieved in people with HIV is suboptimal and response rates are low; therefore, intensified methods for vaccination have been studied in this population. For example, some guidelines endorse reinforced HBV vaccination for immunocompromised patients that includes doubling the antigenic load and re-vaccination. However, the application of standard regimens remains the predominant recommendation regarding the population with HIV. Therefore, this retrospective cohort analysis study determined the response to reinforced HBV vaccination in people with HIV under real-life conditions.

In total, 332 patients with HIV who were seronegative for HBV and who received 3 double-doses of HBV vaccination at 0, 1, and 2 months from a Spanish University Hospital were included. Response to HBV vaccination was assessed and defined as HBV surface antibody concentration of ³10 IU/L at a period of 1 to 12 months after the last dose of the HBV vaccination.

The observed response rate to reinforced HBV vaccination was suboptimal among participants in the HIV-positive cohort. Of the 332 patients included, 256 (77.1%) patients showed a response to HBV vaccination. However, rates of seroprotection significantly increased in subgroups of this population. The median CD4+/CD8+ ratio in responders was 0.75 vs 0.61 in the nonresponders (P =.002). Independent predictors for HBV vaccination response included female gender (P =.002), non-smoking (P =.014), and baseline HIV-RNA £50 copies/mL (P =.024). When all these parameters are combined, almost perfect response rates can be observed. This suggests that individuals with favorable HIV-related factors should not be spared vaccination, especially when they present further predictors of response to reinforced HBV vaccination. Individuals who do not have these favorable factors should be advised not to defer HBV vaccination, but should be vaccinated and monitored and be possible candidates for a routine additional dose.

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Overall, the study authors concluded that, “Accelerated administration of three double-doses results in considerable high, however still suboptimal, response rates to [HBV vaccination] in [patients with HIV] in the clinical practice. A fourth dose should be considered.”

Reference

Neukam K, Gutiérrez-Valencia A, Llaves-Flores S, Espinosa N, Viciana P, López-Cortés. Response to a reinforced hepatitis B vaccination scheme in HIV-infected patients under real-life conditions. Vaccine. 2019;37(20):2758-2763.