Immunogenicity and Immunologic Memory After Hepatitis B Virus Booster Vaccination in HIV-infected Children Receiving Highly Active Antiretroviral Therapy

J Infect Dis. 2009 Sep 15;200(6):935-46. doi: 10.1086/605448.

Abstract

Background: Hepatitis B virus (HBV) is an important cause of comorbidity in human immunodeficiency virus (HIV)-infected individuals. The immunogenicity of HBV vaccination in children receiving highly active antiretroviral therapy (HAART) was investigated.

Methods: HIV-infected children receiving HAART who had low to moderate HIV loads and who had previously received 3 doses of HBV vaccine were given an HBV vaccine booster. Concentrations of antibody to hepatitis B surface antigen (anti-HBs) were determined before vaccination and at weeks 8, 48, and 96. A subset of subjects was administered a subsequent dose, and anti-HBs was measured before and 1 and 4 weeks later.

Results: At entry, 24% of 204 subjects were seropositive. Vaccine response occurred in 46% on the basis of seropositivity 8 weeks after vaccination and in 37% on the basis of a 4-fold rise in antibody concentration. Of 69 subjects given another vaccination 4-5 years later, immunologic memory was exhibited by 45% on the basis of seropositivity 1 week after vaccination and by 29% on the basis of a 4-fold rise in antibody concentration at 1 week. Predictors of response and memory included higher nadir and current CD4 cell percentage, higher CD19 cell percentage, and undetectable HIV load.

Conclusions: HIV-infected children frequently lack protective levels of anti-HBs after previous HBV vaccination, and a significant proportion of them do not respond to booster vaccination or demonstrate memory despite receiving HAART, leaving this population insufficiently protected from infection with HBV.

Trial registration: ClinicalTrials.gov NCT00013871.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active*
  • Child
  • Child, Preschool
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / immunology*
  • Hepatitis B Antibodies / blood
  • Hepatitis B Vaccines / administration & dosage*
  • Hepatitis B Vaccines / immunology*
  • Humans
  • Immunization, Secondary
  • Immunologic Memory / immunology*
  • Male
  • RNA, Viral / blood
  • Time Factors

Substances

  • Anti-HIV Agents
  • Hepatitis B Antibodies
  • Hepatitis B Vaccines
  • RNA, Viral

Associated data

  • ClinicalTrials.gov/NCT00013871