HIV Associated With Nonresponse to HBV Vaccine

Researchers from the University of Washington and Kenyatta National Hospital in Nairobi, Kenya, conducted a prospective interventional study to investigate the response of adults with HIV to hepatitis B virus (HBV) vaccination. The 603 participants were members of the partners' pre-exposure prophylaxis (PrEP) study, and 310 of them had HIV infection. Participants were screened for HBV, and those who were found to be susceptible received HBV vaccine.

Six months after receiving the vaccine, 111 of the participants (35.8 percent) with HIV infection did not have protective HBV surface antibody titers compared to 42 (14.3 percent) of the 293 patients without HIV. A multivariate analysis of the participants with HIV indicated that sex and CD4 counts were associated with nonresponse. Men and participants with CD4 counts lower than 500 cells/mcL were more likely to be nonresponders.

When 102 nonresponders with HIV infection were revaccinated, 72 of them developed a positive antibody response after the first dose and 16 developed antibody response after the third dose. This resulted in a cumulative response of 64.2 percent among participants with HIV after the initial series, 89 percent after the first revaccination dose, and 94.9 percent after the complete revaccination. Nonresponse after revaccination was associated with low BMI, HIV-1 RNA of more than 50,000 copies/mL at baseline, and longer time to revaccination.

Data show that adults in Kenya had similar response to HBV vaccine as patients from developed countries. The researchers suggest that the results may help guide policy on best practices for revaccinating persons with HIV-1 infection who do not respond to the HBV vaccine schedule.

The study, "Immune Response to Hepatitis B Virus Vaccination Among HIV-1 Infected and Uninfected Adults in Kenya," was published in the Journal of Infectious Diseases (2013; 207 (3): 402–410).