Increasing the number of hepatitis B vaccine injections augments anti-HBs response rate in HIV-infected patients. Effects on HIV-1 viral load

• Published in: Vaccine 2000-01, Vol.18 (13), p.1161-1165
• Main Authors: Rey, David, Krantz, Véronique, Partisani, Marialuisa, Schmitt, Marie-Paule, Meyer, Pierre, Libbrecht, Eric, Wendling, Marie-Josée, Vetter, Denis, Nicolle, Margreet, Kempf-Durepaire, Georgette, Lang, Jean-Marie
• Format: Article
• Language: English
• Subjects: Adult; AIDS/HIV; Animals; Anti-HBs; Biological and medical sciences; CD4 Lymphocyte Count; CD4 T lymphocyte count; CHO Cells; Cricetinae; Epidemiology. Vaccinations; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; General aspects; Hepatitis B - blood; Hepatitis B - prevention & control; Hepatitis B - virology; Hepatitis B Antibodies - biosynthesis; Hepatitis B Antibodies - blood; Hepatitis B Antibodies - immunology; Hepatitis B Surface Antigens - blood; Hepatitis B Surface Antigens - immunology; Hepatitis B vaccination; Hepatitis B Vaccines - administration & dosage; HIV Infections - blood; HIV Infections - immunology; HIV Infections - virology; HIV-1; HIV-1 viral load; Human immunodeficiency virus 1; Humans; Immunization Schedule; Infectious diseases; Male; Medical sciences; Microbiology; Middle Aged; Prospective Studies; Vaccines, antisera, therapeutical immunoglobulins and monoclonal antibodies; Viral Load; Virology
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/S0264-410X(99)00389-8

Preventing hepatitis B by vaccination is essential in HIV-infected patients (higher progression rate of HBV infection to chronicity, lower rate of serum HBe Ag loss). However, it has been shown a decreased anti-HBs response in these individuals after a standard vaccination (3 doses of 20 μg). Thus, we tested the hypothesis that doubling the number of hepatitis B vaccine injections might increase anti-HBs response rate. HIV-infected patients with CD4 >200/μl, who were on stable antiretroviral treatment, as well as seronegative for HBV markers, and who have never been vaccinated against HBV, were given 3 intramuscular injections of Genhevac B 20 μg at 1 month intervals. Initial non responders were given 3 additional monthly injections. Anti-HBs titer was followed. We also evaluated the effects on HIV-1 viral load. Twenty patients with a median CD4 cell count of 470/μl were enrolled. The response rate after three 20 μg injections was 55% (11/20), lower in individuals with CD4 between 200 and 500/μl (4/12=33.3%), compared to patients with CD4 above 500/μl (7/8=87.5%, P=0.02). Among 9 initial non-responders, only 2 did not respond to 3 additional doses; thus, the overall response rate was 90% (18/20). Geometric mean titers of anti-HBs were 133 IU/l and 77.5 IU/l, after 3 and 6 Genhevac doses, respectively ( P=0.38). One year later, only 10/17 (58.8%) patients had protective anti-HBs. Five patients experienced a significant viral load increase, transient in 3 cases. These preliminary results suggest that doubling the number of hepatitis B vaccinations in HIV-infected patients might significantly improve anti-HBs response rate; however, close monitoring of anti-HBs is necessary because of its short-lived persistence. The effects on HIV-1 viral load are limited.