TY - JOUR
T1 - Hepatitis B vaccine responses in a large U.S. military cohort of HIV-infected individuals
T2 - Another benefit of HAART in those with preserved CD4 count
AU - Landrum, Michael L.
AU - Hullsiek, Katherine Huppler
AU - Ganesan, Anuradha
AU - Weintrob, Amy C.
AU - Crum-Cianflone, Nancy F.
AU - Barthel, R. Vincent
AU - Peel, Sheila
AU - Agan, Brian K.
N1 - Funding Information:
Support for this work was provided by the Infectious Disease Clinical Research Program (IDCRP) of the Uniformed Services University of the Health Sciences (USUHS). The IDCRP is a DoD tri-service program executed through USUHS and the Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), in collaboration with HHS/NIH/NIAID/DCR through Interagency Agreement HU0001-05-2-0011.
PY - 2009/7/23
Y1 - 2009/7/23
N2 - The influence of highly active antiretroviral therapy (HAART) upon hepatitis B virus (HBV) vaccine responses in HIV-infected individuals is unclear. After classification of vaccinees as non-responders (HBsAb <10 IU/L) or responders (HBsAb ≥10 IU/L) in our HIV cohort, multivariate logistic regression was used to assess factors associated with subsequent vaccine response. Of 626 participants vaccinated from 1988 to 2005, 217 (35%) were vaccine responders. Receipt of ≥3 doses of vaccine (OR 1.83, 95% CI 1.24-2.70), higher CD4 count at vaccination (OR 1.09, 95% CI 1.05-1.13 per 50 cells/μl increase), and use of HAART (OR 2.37, 95% CI 1.56-3.62) were all associated with increased likelihood of developing a response. However, only 49% of those on HAART at last vaccination responded, and 62% of those on HAART, with CD4 count ≥350, and HIV RNA <400 copies/mL responded. Compared to those on HAART with CD4 count ≥350, those not on HAART with CD4 count ≥350 had significantly reduced odds of developing a vaccine response (OR 0.47, 95% CI 0.30-0.70). While HAART use concurrent with HBV immunization was associated with increased probability of responding to the vaccine, the response rate was low for those on HAART. These data provide additional evidence of HAART benefits, even in those with higher CD4 counts, but also highlight the need for improving HBV vaccine immunogenicity.
AB - The influence of highly active antiretroviral therapy (HAART) upon hepatitis B virus (HBV) vaccine responses in HIV-infected individuals is unclear. After classification of vaccinees as non-responders (HBsAb <10 IU/L) or responders (HBsAb ≥10 IU/L) in our HIV cohort, multivariate logistic regression was used to assess factors associated with subsequent vaccine response. Of 626 participants vaccinated from 1988 to 2005, 217 (35%) were vaccine responders. Receipt of ≥3 doses of vaccine (OR 1.83, 95% CI 1.24-2.70), higher CD4 count at vaccination (OR 1.09, 95% CI 1.05-1.13 per 50 cells/μl increase), and use of HAART (OR 2.37, 95% CI 1.56-3.62) were all associated with increased likelihood of developing a response. However, only 49% of those on HAART at last vaccination responded, and 62% of those on HAART, with CD4 count ≥350, and HIV RNA <400 copies/mL responded. Compared to those on HAART with CD4 count ≥350, those not on HAART with CD4 count ≥350 had significantly reduced odds of developing a vaccine response (OR 0.47, 95% CI 0.30-0.70). While HAART use concurrent with HBV immunization was associated with increased probability of responding to the vaccine, the response rate was low for those on HAART. These data provide additional evidence of HAART benefits, even in those with higher CD4 counts, but also highlight the need for improving HBV vaccine immunogenicity.
KW - Hepatitis B vaccine
KW - Hepatitis B virus
KW - Highly active antiretroviral therapy
KW - Human immunodeficiency virus
KW - Immunization
UR - http://www.scopus.com/inward/record.url?scp=67649467275&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2009.04.016
DO - 10.1016/j.vaccine.2009.04.016
M3 - Article
C2 - 19540026
AN - SCOPUS:67649467275
SN - 0264-410X
VL - 27
SP - 4731
EP - 4738
JO - Vaccine
JF - Vaccine
IS - 34
ER -