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HIV-Positive Patients Show Lower Response to Hepatitis B Vaccination Even at Double Doses: Presented at BHIVA By Evelyn Harvey LIVERPOOL, United Kingdom -- April 7, 2009 -- Individuals who are HIV-positive (+) have a reduced response to the intramuscular hepatitis B virus (HBV) vaccine (Engerix) compared with HIV-negative (-) vaccine recipients, even when a double dose of the vaccine is given, according to a study presented here at the 15th Annual Conference of the British HIV Association (BHIVA). The study, led by Kaveh Manavi, MD, University Hospitals, Birmingham, United Kingdom, also found that fewer HIV+ patients than HIV-negative (-) controls had Anti-HBsAb >10 IU/L -- the standard measure of the protective immune response. "Patients with HIV have an increased risk of HBV due to the shared transmission routes of the viruses. Vaccination is recommended, but studies have suggested that immunity after standard vaccination is lower in HIV+ patients," the authors said. "We undertook a study to investigate the response rate of a group of HIV+ patients to double-dose HBV vaccination, compared with the response to standard-dose vaccination in HIV- controls." Current recommendations in the United Kingdom are that all newly diagnosed HIV+ patients should be screened for HBV immunity and offered vaccination if anti-HB antibodies are not present. A total of 51 HIV+ patients and 48 HIV- patients who had no evidence of prior exposure to HBV completed the course of HBV vaccination during the study period (June-December 2007). All patients received the intramuscular HBV vaccination. HIV- patients received a standard dose of 1 ml on days 0, 7, and 21, with a booster after 1 year. HIV+ patients were given 2 ml of vaccine at 0, 1, and 4 months. Patients' anti-HBsAb titre was determined after completion of the course. For HIV+ patients, CD4 cell count at first vaccination was recorded. Anti-HBsAb >10 IU/L was seen in 65% of the HIV+ patients and 92% of the HIV-patients, demonstrating a significant difference in response (P = .002). Among the HIV+ patients, no significant differences were seen in median CD4 cell count between those who responded to the HBV vaccine and those who did not. Looking at CD4 levels, 68% of patients with CD4 counts >200 cells/mm3 responded to the vaccine, compared to 55% of those with CD4 counts <200 cells/mm3, but this trend was not statistically significant. "The HBV vaccination response of HIV-uninfected patients was signi€cantly higher than HIV-infected patients," the authors concluded. "Even after administration of double dose vaccination to HIV-infected patients, their response remained signi€cantly less than that of HIV-uninfected patients immunised with a standard dose. HBV vaccination response was more likely among patients with CD4 count of above 200." Funding for this study was provided by University Hospitals Birmingham NHS Foundation Trust. [Presentation title: HBV Vaccine Response of HIV-Infected Patients Immunized With Double Dose Engerix Compared With Vaccination Response of HIV-Uninfected Patients Vaccinated With Standard Dose of Engerix. Poster 112] E-mail this page to a friend or colleague! To print, use this version