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Fernandez-Fuertes M, Macias J, Corma-Gomez A, Salazar-Gonzalez A, Gonzalez-Serna A, Rincon P, Arriaza-Estevez MJ, Fuentes-Lopez A, Real LM, Pineda JA. Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville, Southern Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:251-256. [PMID: 37230839 DOI: 10.1016/j.eimce.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/08/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Periodic outbreaks of hepatitis A (HAV) infection in men who have sex with men (MSM) have been reported. Low vaccination uptake in HIV-infected individuals could drive new outbreaks. We aimed at evaluating the incidence of and risk factors for HAV infection in people living with HIV (PLWH) in our area. We also assessed the rates of HAV vaccination. METHODS This was a prospective cohort study. 915 patients were included, 272 (30%) of them were anti-HAV seronegative at baseline. RESULTS Twenty-six (9.6%) susceptible individuals became infected. Incident cases peaked in 2009-2010 and 2017-2018. Incident HAV infection was independently associated with MSM [adjusted odds ratio (95% confidence ratio): 4.39 (1.35-14.27), p=0.014]. One hundred and five (38.6%) HAV seronegative patients were vaccinated, 21 (20%) of them did not respond, and one (1%) patient lost immunity against HAV. Four (29%) non-responders to vaccination showed incident HAV 5-9 years afterwards. CONCLUSIONS The incidence of HAV infection in a cohort of well-controlled PLWH remains low and stable, with intermittent outbreaks involving mainly non-immunized MSM. A significant proportion of PLWH remain susceptible to HAV infection due to insufficient vaccine uptake and limited response to vaccination. Importantly, patients not responding to HAV vaccination continue at risk of infection.
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Affiliation(s)
- Marta Fernandez-Fuertes
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Macias
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; Department of Medicine, University of Sevilla, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Anaïs Corma-Gomez
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alejandro Gonzalez-Serna
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Rincon
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria J Arriaza-Estevez
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Fuentes-Lopez
- Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain
| | - Luis M Real
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Malaga, Malaga, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan A Pineda
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain; Department of Medicine, University of Sevilla, Sevilla, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Koga M, Saito M, Kubota M, Senkoji T, Adachi E, Ikeuchi K, Kikuchi T, Otani A, Takahashi K, Tsutsumi T, Yotsuyanagi H. Attenuation of hepatitis A antibody after immunization with hepatitis A vaccine (Aimmugen) in people living with HIV. Hepatol Res 2024; 54:487-494. [PMID: 38263905 DOI: 10.1111/hepr.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/11/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
AIM Hepatitis A (HA) is a vaccine-preventable disease. In regions with good sanitation, men who have sex with men (MSM) are the key affected populations. During the 2018-2019 HA outbreak among MSM in Japan, we actively vaccinated MSM living with HIV (MSM-LWHIV) with Aimmugen. As previously reported, their antibody seroconversion rate due to vaccination was lower than that of healthy individuals. However, the durability of Aimmugen in people living with HIV has not yet been reported. We evaluated attenuation after the one-series vaccination (comprising three inoculations) and the factors associated with attenuation. METHODS We retrospectively examined anti-HA immunoglobulin G (anti-HA-IgG) titers and other clinical data from our hospital's medical records. Patients with no history of vaccination or HA infection (i.e., negative HA-IgG titers) who received one series of Aimmugen, achieved seropositivity, and anti-HA-IgG antibodies were tested ≥2 years after three doses were included. Fisher's exact test and the Mann-Whitney U-test were performed. p < 0.05 was considered statistically significant. RESULTS Fifty-one MSM-LWHIV were included. All were seropositive after the third dose with a median HA-IgG titer of 10.1 (interquartile range, 7.2-12.2) (sample/cut-off values [s/co]). In 45 (40-49) months, seropositivity decreased to 90% (46/51) and was attenuated to a median of 4.4 (2.3-6.5) s/co. Lower baseline B cell counts (p = 0.049), lower anti-HA-IgG levels after the second dose (p = 0.002), and lower anti-HA-IgG levels after the third dose (p = 0.003) were associated with seronegativity. CONCLUSIONS Anti-HA-IgG titers of vaccinated MSM-LWHIV may be attenuated; thus, additional immunizations should be considered.
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Affiliation(s)
- Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Megumi Kubota
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tomoe Senkoji
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ikeuchi
- Department of Infectious Diseases and Applied Immunology, Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tadashi Kikuchi
- Department of Infectious Diseases and Applied Immunology, Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Amato Otani
- Department of Infectious Diseases and Applied Immunology, Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazuaki Takahashi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takeya Tsutsumi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, Hospital of the Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Costiniuk CT, Lee T, Singer J, Galipeau Y, Arnold C, Langlois MA, Needham J, Jenabian MA, Burchell AN, Samji H, Chambers C, Walmsley S, Ostrowski M, Kovacs C, Tan DHS, Harris M, Hull M, Brumme ZL, Lapointe HR, Brockman MA, Margolese S, Mandarino E, Samarani S, Lebouché B, Angel JB, Routy JP, Cooper CL, Anis AH. Correlates of Breakthrough SARS-CoV-2 Infections in People with HIV: Results from the CIHR CTN 328 Study. Vaccines (Basel) 2024; 12:447. [PMID: 38793698 PMCID: PMC11125718 DOI: 10.3390/vaccines12050447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/26/2024] Open
Abstract
COVID-19 breakthrough infection (BTI) can occur despite vaccination. Using a multi-centre, prospective, observational Canadian cohort of people with HIV (PWH) receiving ≥2 COVID-19 vaccines, we compared the SARS-CoV-2 spike (S) and receptor-binding domain (RBD)-specific IgG levels 3 and 6 months post second dose, as well as 1 month post third dose, in PWH with and without BTI. BTI was defined as positivity based on self-report measures (data up to last study visit) or IgG data (up to 1 month post dose 3). The self-report measures were based on their symptoms and either a positive PCR or rapid antigen test. The analysis was restricted to persons without previous COVID-19 infection. Persons without BTI remained COVID-19-naïve until ≥3 months following the third dose. Of 289 participants, 92 developed BTI (31.5 infections per 100 person-years). The median days between last vaccination and BTI was 128 (IQR 67, 176), with the most cases occurring between the third and fourth dose (n = 59), corresponding to the Omicron wave. In analyses adjusted for age, sex, race, multimorbidity, hypertension, chronic kidney disease, diabetes and obesity, a lower IgG S/RBD (log10 BAU/mL) at 1 month post dose 3 was significantly associated with BTI, suggesting that a lower IgG level at this time point may predict BTI in this cohort of PWH.
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Affiliation(s)
- Cecilia T. Costiniuk
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital—Glen Site, Montreal, QC H4A 3J1, Canada; (S.S.); (B.L.); (J.-P.R.)
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Experimental Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | - Terry Lee
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC V6Z 1Y6, Canada; (T.L.); (J.N.); (S.M.); (E.M.); (A.H.A.)
- Centre for Advancing Health Outcomes, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Joel Singer
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC V6Z 1Y6, Canada; (T.L.); (J.N.); (S.M.); (E.M.); (A.H.A.)
- Centre for Advancing Health Outcomes, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Yannick Galipeau
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (Y.G.); (C.A.); (M.-A.L.); (J.B.A.)
| | - Corey Arnold
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (Y.G.); (C.A.); (M.-A.L.); (J.B.A.)
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (Y.G.); (C.A.); (M.-A.L.); (J.B.A.)
| | - Judy Needham
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC V6Z 1Y6, Canada; (T.L.); (J.N.); (S.M.); (E.M.); (A.H.A.)
- Centre for Advancing Health Outcomes, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, QC H2X 1Y4, Canada;
| | - Ann N. Burchell
- Department of Family and Community Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada;
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
| | - Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (H.S.); (Z.L.B.); (M.A.B.)
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
| | - Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada;
| | - Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada;
| | - Mario Ostrowski
- Clinical Sciences Division, Department of Immunology, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1T8, Canada;
| | - Colin Kovacs
- Division of Infectious Diseases, Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada;
| | - Darrell H. S. Tan
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada;
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada;
- Institute of Public Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 3M6, Canada
| | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (M.H.); (M.H.)
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (M.H.); (M.H.)
| | - Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (H.S.); (Z.L.B.); (M.A.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (M.H.); (M.H.)
| | - Hope R. Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (M.H.); (M.H.)
| | - Mark A. Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (H.S.); (Z.L.B.); (M.A.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (M.H.); (M.H.)
- Department of Molecular Biology and Biochemistry, Faculty of Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Shari Margolese
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC V6Z 1Y6, Canada; (T.L.); (J.N.); (S.M.); (E.M.); (A.H.A.)
| | - Enrico Mandarino
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC V6Z 1Y6, Canada; (T.L.); (J.N.); (S.M.); (E.M.); (A.H.A.)
| | - Suzanne Samarani
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital—Glen Site, Montreal, QC H4A 3J1, Canada; (S.S.); (B.L.); (J.-P.R.)
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Bertrand Lebouché
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital—Glen Site, Montreal, QC H4A 3J1, Canada; (S.S.); (B.L.); (J.-P.R.)
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3S 1Z1, Canada
| | - Jonathan B. Angel
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (Y.G.); (C.A.); (M.-A.L.); (J.B.A.)
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Jean-Pierre Routy
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital—Glen Site, Montreal, QC H4A 3J1, Canada; (S.S.); (B.L.); (J.-P.R.)
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Division of Hematology, Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Curtis L. Cooper
- Division of Infectious Diseases, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Aslam H. Anis
- CIHR Canadian HIV Trials Network (CTN), Vancouver, BC V6Z 1Y6, Canada; (T.L.); (J.N.); (S.M.); (E.M.); (A.H.A.)
- Centre for Advancing Health Outcomes, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Tortellini E, Fosso Ngangue YC, Dominelli F, Guardiani M, Falvino C, Mengoni F, Carraro A, Marocco R, Pasculli P, Mastroianni CM, Ciardi MR, Lichtner M, Zingaropoli MA. Immunogenicity and Efficacy of Vaccination in People Living with Human Immunodeficiency Virus. Viruses 2023; 15:1844. [PMID: 37766251 PMCID: PMC10534440 DOI: 10.3390/v15091844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
People living with HIV (PLWH) remain at high risk of mortality and morbidity from vaccine-preventable diseases, even though antiretroviral therapy (ART) has restored life expectancy and general well-being. When, which, and how many doses of vaccine should be administered over the lifetime of PLWH are questions that have become clinically relevant. Immune responses to most vaccines are known to be impaired in PLWH. Effective control of viremia with ART and restored CD4+ T-cell count are correlated with an improvement in responsiveness to routine vaccines. However, the presence of immune alterations, comorbidities and co-infections may alter it. In this article, we provide a comprehensive review of the literature on immune responses to different vaccines in the setting of HIV infection, emphasizing the potential effect of HIV-related factors and presence of comorbidities in modulating such responses. A better understanding of these issues will help guide vaccination and prevention strategies for PLWH.
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Affiliation(s)
- Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Yann Collins Fosso Ngangue
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Carmen Falvino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Miriam Lichtner
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
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Chen GJ, Sun HY, Lin KY, Hsieh SM, Chuang YC, Liu WD, Huang YS, Pan SC, Wu UI, Cheng A, Huang YC, Wu CH, Su YC, Liu WC, Chang SY, Hung CC. A Randomized Clinical Trial of 1-Dose vs Accelerated 2-Dose Schedule for Hepatitis A Virus (HAV) Revaccination Among People With Human Immunodeficiency Virus Who Were Nonresponders or Had Seroreversion After Primary HAV Vaccination. Clin Infect Dis 2023; 77:529-536. [PMID: 37036404 DOI: 10.1093/cid/ciad206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND For people with human immunodeficiency virus (PWH) who have no serological responses to their primary hepatitis A virus (HAV) vaccination or have seroreversion after successful primary vaccination, the optimal revaccination strategy remains unclear. METHODS In this open-label, randomized clinical trial, PWH who tested negative for anti-HAV antibodies after receiving a standard 2-dose series of primary HAV vaccination were enrolled and assigned in a 1:1 ratio to receive either 1 dose (the 1-dose group) or 2 doses of HAV vaccine administered 4 weeks apart (the 2-dose group). Serological response rates and anti-HAV antibody titers were compared at weeks 24 and 48. RESULTS Of the 153 participants (77 in the 1-dose group and 76 in the 2-dose group), the overall serological response rates at week 48 after revaccination were similar between the 2 groups (2- vs 1-dose, 80.2% vs 71.4%, P = .20). However, anti-HAV antibody titers were consistently higher in the 2-dose group than in the 1-dose group. In subgroup analysis, PWH who were nonresponders to primary HAV vaccination were significantly more likely to mount a serological response after 2-dose HAV revaccination (68.4% vs 44.1%, P = .038). No severe adverse events were reported throughout the study. CONCLUSIONS Two-dose HAV revaccination administered 4 weeks apart yielded similar serological responses as 1-dose revaccination among PWH who were nonresponders or had seroreversion after primary HAV vaccination. The 2-dose revaccination schedule generated significantly higher anti-HAV antibody titers and was more likely to elicit serological responses at week 48 among PWH who were nonresponders to primary HAV vaccination. Clinical Trials Registration. NCT03855176.
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Affiliation(s)
- Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Infection Control Room, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chung Chuang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Un-In Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Chia Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Cheng-Hsin Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sui-Yuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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Abimbola TO, Van Handel M, Tie Y, Ouyang L, Nelson N, Weiser J. Cost-effectiveness of expanded hepatitis A vaccination among adults with diagnosed HIV, United States. PLoS One 2023; 18:e0282972. [PMID: 36930611 PMCID: PMC10022807 DOI: 10.1371/journal.pone.0282972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
Hepatitis A virus can cause severe and prolonged illness in persons with HIV (PWH). In July 2020, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendation for hepatitis A vaccination to include all PWH aged ≥1 year. We used a decision analytic model to estimate the value of vaccinating a cohort of adult PWH aged ≥20 years with diagnosed HIV in the United States using a limited societal perspective. The model compared 3 scenarios over an analytic horizon of 1 year: no vaccination, current vaccine coverage, and full vaccination. We incorporated the direct medical costs and nonmedical costs (i.e., public health costs and productivity loss). We estimated the total number of infections averted, cost to vaccinate, and incremental cost per case averted. Full implementation of the ACIP recommendation resulted in 775 to 812 fewer adult cases of hepatitis A in 1 year compared with the observed vaccination coverage. The incremental cost-effectiveness ratio for the full vaccination scenario was $48,000 for the 2-dose single-antigen hepatitis A vaccine and $130,000 for the 3-dose combination hepatitis A and hepatitis B vaccine per case averted, compared with the observed vaccination scenario. Depending on type of vaccine, full hepatitis A vaccination of PWH could lead to ≥80% reduction in the number of cases and $48,000 to $130,000 in additional cost per case averted. Data on hepatitis A health outcomes and costs specific to PWH are needed to better understand the longer-term costs and benefits of the 2020 ACIP recommendation.
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Affiliation(s)
- Taiwo O. Abimbola
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Michelle Van Handel
- National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yunfeng Tie
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lijing Ouyang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Noele Nelson
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Weiser
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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7
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Costiniuk CT, Singer J, Langlois MA, Kulic I, Needham J, Burchell A, Jenabian MA, Walmsley S, Ostrowski M, Kovacs C, Tan D, Harris M, Hull M, Brumme Z, Brockman M, Margolese S, Mandarino E, Angel JB, Routy JP, Anis AH, Cooper C. CTN 328: immunogenicity outcomes in people living with HIV in Canada following vaccination for COVID-19 (HIV-COV): protocol for an observational cohort study. BMJ Open 2021; 11:e054208. [PMID: 34916326 PMCID: PMC8678543 DOI: 10.1136/bmjopen-2021-054208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 11/25/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Most existing vaccines require higher or additional doses or adjuvants to provide similar protection for people living with HIV (PLWH) compared with HIV-uninfected individuals. Additional research is necessary to inform COVID-19 vaccine use in PLWH. METHODS AND ANALYSIS This multicentred observational Canadian cohort study will enrol 400 PLWH aged >16 years from Montreal, Ottawa, Toronto and Vancouver. Subpopulations of PLWH of interest will include individuals: (1) >55 years of age; (2) with CD4 counts <350 cells/mm3; (3) with multimorbidity (>2 comorbidities) and (4) 'stable' or 'reference' PLWH (CD4 T cells >350 cells/mm3, suppressed viral load for >6 months and <1 comorbidity). Data for 1000 HIV-negative controls will be obtained via a parallel cohort study (Stop the Spread Ottawa), using similar time points and methods. Participants receiving >1 COVID-19 vaccine will attend five visits: prevaccination; 1 month following the first vaccine dose; and at 3, 6 and 12 months following the second vaccine dose. The primary end point will be the percentage of PLWH with COVID-19-specific antibodies at 6 months following the second vaccine dose. Humoral and cell-mediated immune responses, and the interplay between T cell phenotypes and inflammatory markers, will be described. Regression techniques will be used to compare COVID-19-specific immune responses to determine whether there are differences between the 'unstable' PLWH group (CD4 <350 cells/mm3), the stable PLWH cohort and the HIV-negative controls, adjusting for factors believed to be associated with immune response. Unadjusted analyses will reveal whether there are differences in driving factors associated with group membership. ETHICS AND DISSEMINATION Research ethics boards at all participating institutions have granted ethics approval for this study. Written informed consent will be obtained from all study participants prior to enrolment. The findings will inform the design of future COVID-19 clinical trials, dosing strategies aimed to improve immune responses and guideline development for PLWH. TRIAL REGISTRATION NUMBER NCT04894448.
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Affiliation(s)
- Cecilia T Costiniuk
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Joel Singer
- Canadian Institutes of Health Research (CIHR)--Canadian HIV Trials Network and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc-André Langlois
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Iva Kulic
- Canadian Institutes of Health Research (CIHR)--Canadian HIV Trials Network and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Judy Needham
- Canadian Institutes of Health Research (CIHR)--Canadian HIV Trials Network and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ann Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Ontario, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences and CERMO-FC Research Centre, Université du Québec à Montréal (UQAM), Montreal, Quebec, Canada
| | - Sharon Walmsley
- Department of Medicine, Division of Infectious Diseases, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mario Ostrowski
- Clinical Sciences Division and Department of Immunology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Infectious Diseases, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Colin Kovacs
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
| | - Darrell Tan
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Montreal, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marianne Harris
- Brisith Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Mark Hull
- Brisith Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Zabrina Brumme
- Brisith Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mark Brockman
- Brisith Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Shari Margolese
- Community Advisory Committee, CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Enrico Mandarino
- Community Advisory Committee, CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Jonathan B Angel
- Department of Medicine, Division of Infectious Diseases, The Ottawa Hospital, The Ottawa Hospital Research Institute and Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean-Pierre Routy
- Department of Medicine, Division of Hematology and Chronic Viral Illness Service, McGill University Health Centre, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Aslam H Anis
- Canadian Institutes of Health Research (CIHR)--Canadian HIV Trials Network and Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Curtis Cooper
- Department of Medicine, Division of Infectious Diseases, The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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8
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McLaughlin SE, Simmons JD, Armstrong H, Gonzales E, Rakita RM, Duchin JS, Patel RC. Acute Hepatitis A Viral Infection in People With HIV With Previously Documented Hepatitis A Immunity or Appropriate Vaccination: A Case Series. Open Forum Infect Dis 2021; 8:ofab347. [PMID: 34377728 PMCID: PMC8339277 DOI: 10.1093/ofid/ofab347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/29/2021] [Indexed: 11/14/2022] Open
Abstract
We describe 4 people with HIV (PWH) who acquired acute hepatitis A (HAV) infection during recent King County, Washington, outbreaks despite documented immunity and/or vaccination. HAV revaccination may be needed in PWH with risk factors for HAV infection regardless of preexisting immunity.
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Affiliation(s)
- Stephanie E McLaughlin
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jason D Simmons
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Hilary Armstrong
- Public Health - Seattle and King County, Seattle, Washington, USA
| | - Elysia Gonzales
- Public Health - Seattle and King County, Seattle, Washington, USA
| | - Robert M Rakita
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jeffrey S Duchin
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA.,Public Health - Seattle and King County, Seattle, Washington, USA
| | - Rena C Patel
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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9
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Herzog C, Van Herck K, Van Damme P. Hepatitis A vaccination and its immunological and epidemiological long-term effects - a review of the evidence. Hum Vaccin Immunother 2021; 17:1496-1519. [PMID: 33325760 PMCID: PMC8078665 DOI: 10.1080/21645515.2020.1819742] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccines have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.
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Affiliation(s)
- Christian Herzog
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Koen Van Herck
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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10
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Nelson NP, Weng MK, Hofmeister MG, Moore KL, Doshani M, Kamili S, Koneru A, Haber P, Hagan L, Romero JR, Schillie S, Harris AM. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020; 69:1-38. [PMID: 32614811 PMCID: PMC8631741 DOI: 10.15585/mmwr.rr6905a1] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
HEPATITIS A IS A VACCINE-PREVENTABLE, COMMUNICABLE DISEASE OF THE LIVER CAUSED BY THE HEPATITIS A VIRUS (HAV). THE INFECTION IS TRANSMITTED VIA THE FECAL-ORAL ROUTE, USUALLY FROM DIRECT PERSON-TO-PERSON CONTACT OR CONSUMPTION OF CONTAMINATED FOOD OR WATER. HEPATITIS A IS AN ACUTE, SELF-LIMITED DISEASE THAT DOES NOT RESULT IN CHRONIC INFECTION. HAV ANTIBODIES (IMMUNOGLOBULIN G [IGG] ANTI-HAV) PRODUCED IN RESPONSE TO HAV INFECTION PERSIST FOR LIFE AND PROTECT AGAINST REINFECTION; IGG ANTI-HAV PRODUCED AFTER VACCINATION CONFER LONG-TERM IMMUNITY. THIS REPORT SUPPLANTS AND SUMMARIZES PREVIOUSLY PUBLISHED RECOMMENDATIONS FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) REGARDING THE PREVENTION OF HAV INFECTION IN THE UNITED STATES. ACIP RECOMMENDS ROUTINE VACCINATION OF CHILDREN AGED 12-23 MONTHS AND CATCH-UP VACCINATION FOR CHILDREN AND ADOLESCENTS AGED 2-18 YEARS WHO HAVE NOT PREVIOUSLY RECEIVED HEPATITIS A (HEPA) VACCINE AT ANY AGE. ACIP RECOMMENDS HEPA VACCINATION FOR ADULTS AT RISK FOR HAV INFECTION OR SEVERE DISEASE FROM HAV INFECTION AND FOR ADULTS REQUESTING PROTECTION AGAINST HAV WITHOUT ACKNOWLEDGMENT OF A RISK FACTOR. THESE RECOMMENDATIONS ALSO PROVIDE GUIDANCE FOR VACCINATION BEFORE TRAVEL, FOR POSTEXPOSURE PROPHYLAXIS, IN SETTINGS PROVIDING SERVICES TO ADULTS, AND DURING OUTBREAKS.
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11
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Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterol Clin North Am 2020; 49:191-199. [PMID: 32389358 PMCID: PMC7883407 DOI: 10.1016/j.gtc.2020.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis A virus (HAV) is a positive-strand RNA virus that is transmitted feco-orally through person-to-person contact. Outbreaks are often linked to poor sanitation, overcrowding, or food and water contamination. Infection is often asymptomatic in children, but adults present with jaundice, abdominal pain, hepatitis, and hyperbilirubinemia. Diagnosis is through detection of immunoglobulin M antibodies against HAV, and treatment is supportive. Vaccination is the mainstay of prevention and should be given before exposure whenever possible.
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12
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Huang S, Huang C, Wang N, Chen T, Lee Y, Lin S, Lin T, Lin C, Lee Y, Lee C, Chen C, Lin K, Chen G, Liu C, Cheng S, Lu P, Yang C, Hung C. Early Seroreversion After 2 Doses of Hepatitis A Vaccination in Human Immunodeficiency Virus-Positive Patients: Incidence and Associated Factors. Hepatology 2019; 70:465-475. [PMID: 30614542 PMCID: PMC6767446 DOI: 10.1002/hep.30495] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/04/2019] [Indexed: 12/13/2022]
Abstract
Serological responses (Seroresponse) and durability of hepatitis A virus (HAV) vaccination are reduced among human immunodeficiency virus (HIV)-positive patients. Incidence of and associated factors with early seroreversion (loss of seroresponse) among HIV-positive patients who have achieved seroresponses after two doses of HAV vaccination remain unclear. In this multicenter study, we followed HIV-positive adults who had mounted seroresponses after completing two doses of HAV vaccination during a recent outbreak of acute hepatitis A between 2015 and 2017, a 1:4 case-control study was conducted to identify factors associated with seroreversion. Case patients were those with seroreversion, and controls were those with similar follow-up durations who were able to maintain seroresponses. During the study period, 49 of the 1,256 patients (3.9%) seroreverted after a median follow-up of 611 days. In a case-control study, seroreversion was more likely to occur in patients with a higher weight (adjusted odds ratio [aOR], 1.703; 95% confidence interval [CI], 1.292-2.323, per 10-kg increment) and HIV viremia at the time of vaccination (aOR, 2.922; 95% CI, 1.067-7.924), whereas positive seroresponse at 6 months of HAV vaccination and higher CD4 lymphocyte counts at vaccination were inversely associated with early seroreversion with an aOR of 0.059 (95% CI, 0.020-0.154) and 0.837 (95% CI, 0.704-0.979, per 100-cell/mm3 increment), respectively, in multivariable analyses. Conclusion: During an outbreak setting, early seroreversion following two-dose HAV vaccination occurred in 3.9% of HIV-positive patients. Lower and delayed seroresponses to HAV vaccination, a higher weight, and HIV viremia and lower CD4 lymphocyte counts at the time of HAV vaccination were associated with early seroreversion. Regular monitoring of seroresponse and booster vaccination might be warranted, especially in HIV-positive adults with predictors of early seroreversion.
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Affiliation(s)
- Sung‐Hsi Huang
- Department of Internal MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsin‐ChuTaiwan,Department of Tropical Medicine and ParasitologyNational Taiwan University College of MedicineTaipeiTaiwan
| | - Chung‐Hao Huang
- Department of Internal MedicineKaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Ning‐Chi Wang
- Department of Internal Medicine, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Tun‐Chieh Chen
- Department of Internal MedicineKaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical UniversityKaohsiungTaiwan,Department of Internal MedicineKaohsiung Municipal Ta‐Tung HospitalKaohsiungTaiwan
| | - Yuan‐Ti Lee
- School of MedicineChung Shan Medical UniversityTaichungTaiwan,Department of Internal MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Shih‐Ping Lin
- Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
| | - Te‐Yu Lin
- Department of Internal Medicine, Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Chi‐Ying Lin
- Department of Internal MedicineNational Taiwan University Hospital Yun‐Lin BranchYun‐LinTaiwan
| | - Yu‐Lin Lee
- Department of Internal MedicineChanghua Christian HospitalChanghuaTaiwan
| | - Chen‐Hsiang Lee
- Department of Internal MedicineKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Cheng‐Pin Chen
- Department of Internal MedicineTaoyuan General Hospital, Ministry of Health and WelfareTaoyuanTaiwan
| | - Kuan‐Yin Lin
- Department of MedicineNational Taiwan University Hospital Jin‐Shan BranchNew Taipei CityTaiwan
| | - Guan‐Jhou Chen
- Department of Internal MedicineNational Taiwan University Hospital Yun‐Lin BranchYun‐LinTaiwan
| | - Chun‐Eng Liu
- Department of Internal MedicineChanghua Christian HospitalChanghuaTaiwan
| | - Shu‐Hsing Cheng
- Department of Internal MedicineTaoyuan General Hospital, Ministry of Health and WelfareTaoyuanTaiwan,School of Public HealthTaipei Medical UniversityTaipeiTaiwan
| | - Po‐Liang Lu
- Department of Internal MedicineKaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Chia‐Jui Yang
- Department of Internal MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan,School of MedicineNational Yang‐Ming UniversityTaipeiTaiwan
| | - Chien‐Ching Hung
- Department of Tropical Medicine and ParasitologyNational Taiwan University College of MedicineTaipeiTaiwan,Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
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13
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Brennan J, Moore K, Sizemore L, Mathieson SA, Wester C, Dunn JR, Schaffner W, Jones TF. Notes from the Field: Acute Hepatitis A Virus Infection Among Previously Vaccinated Persons with HIV Infection - Tennessee, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:328-329. [PMID: 30973852 PMCID: PMC6459582 DOI: 10.15585/mmwr.mm6814a3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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14
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El Chaer F, El Sahly HM. Vaccination in the Adult Patient Infected with HIV: A Review of Vaccine Efficacy and Immunogenicity. Am J Med 2019; 132:437-446. [PMID: 30611828 DOI: 10.1016/j.amjmed.2018.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022]
Abstract
Patients infected with HIV remain at increased risk of mortality and morbidity from diseases that are preventable with vaccines partly due to the persisting immunopathology that results in impaired responses to vaccination despite virologic suppression. Because data on clinical effectiveness in patients who are immunocompromised remain limited, undervaccination of individuals with HIV poses a major concern. Multiple societies have published recommendations on vaccination in individuals infected with HIV. Many of these recommendations are based on extrapolation of data from clinical trials that usually exclude patients with HIV, although there is a growing body of data from patients infected with HIV as well. In this review, we describe the available literature on vaccine response in the adult patient with HIV as measured by immunogenicity or vaccine efficacy.
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Affiliation(s)
- Firas El Chaer
- Department of Medicine, University of Maryland School of Medicine, Baltimore; University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
| | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Tx.
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15
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Fritzsche C, Bergmann L, Loebermann M, Glass A, Reisinger EC. Immune response to hepatitis A vaccine in patients with HIV. Vaccine 2019; 37:2278-2283. [PMID: 30890384 DOI: 10.1016/j.vaccine.2019.02.064] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/10/2019] [Accepted: 02/19/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of various factors that may influence the immunologic response to hepatitis A mono-vaccine or hepatitis A/B co-vaccine (Twinrix®) in HIV-infected patients. DESIGN Retrospective cross-sectional study. METHODS HIV positive patients with a full course of hepatitis A vaccine were tested for HAV antibodies. The seroconversion rates were determined, and the influence of several factors including CD4 cell counts, CD4/CD8 ratio, plasma viral load, type of vaccine, and antiretroviral therapy at the time of vaccine, was evaluated. RESULTS After vaccination, 80.2% of the patients developed anti-HAV antibodies, 81.5% in the mono-vaccine group and 79.2% in the hepatitis A/B co-vaccine group. In the mono-vaccine group, factors significantly associated with a better response to the vaccine were higher CD4 cell count, higher CD4/CD8 ratio, and shorter time interval from vaccine to serological control. In patients who received the hepatitis A/B co-vaccine, younger age and female sex were significantly associated with better vaccine response. Multivariable logistic regression analysis revealed time interval from vaccine to serological control of more than 5 years vs. less than 1 year to be significantly associated with decrease of seroconversion after HAV vaccine. CONCLUSIONS The response to hepatitis A vaccine is impaired in HIV positive patients. HIV patients, at least those older than 30, should be tested for seroconversion after receiving the hepatitis A vaccine. As hepatitis A titers may rapidly decline, control serology during follow-up should be proposed, possibly within two years. However, vaccine type does not play a role in vaccine response.
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Affiliation(s)
- Carlos Fritzsche
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, All University Medical School of Rostock, Germany.
| | - Lisa Bergmann
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, All University Medical School of Rostock, Germany
| | - Micha Loebermann
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, All University Medical School of Rostock, Germany
| | - Aenne Glass
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, All University Medical School of Rostock, Germany
| | - Emil C Reisinger
- Division of Tropical Medicine and Infectious Diseases, Department of Medicine, All University Medical School of Rostock, Germany
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16
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Monette A, Mouland AJ. T Lymphocytes as Measurable Targets of Protection and Vaccination Against Viral Disorders. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2019; 342:175-263. [PMID: 30635091 PMCID: PMC7104940 DOI: 10.1016/bs.ircmb.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Continuous epidemiological surveillance of existing and emerging viruses and their associated disorders is gaining importance in light of their abilities to cause unpredictable outbreaks as a result of increased travel and vaccination choices by steadily growing and aging populations. Close surveillance of outbreaks and herd immunity are also at the forefront, even in industrialized countries, where previously eradicated viruses are now at risk of re-emergence due to instances of strain recombination, contractions in viral vector geographies, and from their potential use as agents of bioterrorism. There is a great need for the rational design of current and future vaccines targeting viruses, with a strong focus on vaccine targeting of adaptive immune effector memory T cells as the gold standard of immunity conferring long-lived protection against a wide variety of pathogens and malignancies. Here, we review viruses that have historically caused large outbreaks and severe lethal disorders, including respiratory, gastric, skin, hepatic, neurologic, and hemorrhagic fevers. To observe trends in vaccinology against these viral disorders, we describe viral genetic, replication, transmission, and tropism, host-immune evasion strategies, and the epidemiology and health risks of their associated syndromes. We focus on immunity generated against both natural infection and vaccination, where a steady shift in conferred vaccination immunogenicity is observed from quantifying activated and proliferating, long-lived effector memory T cell subsets, as the prominent biomarkers of long-term immunity against viruses and their associated disorders causing high morbidity and mortality rates.
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17
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Sabrià A, Gregori J, Garcia-Cehic D, Guix S, Pumarola T, Manzanares-Laya S, Caylà JA, Bosch A, Quer J, Pintó RM. Evidence for positive selection of hepatitis A virus antigenic variants in vaccinated men-having-sex-with men patients: Implications for immunization policies. EBioMedicine 2018; 39:348-357. [PMID: 30472089 PMCID: PMC6354442 DOI: 10.1016/j.ebiom.2018.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 01/23/2023] Open
Abstract
Background A huge outbreak in the men-having-sex-with-men (MSM) has hit Europe during the years 2016–2018. Outbreak control has been hampered by vaccine shortages in many countries, and to minimize their impact, reduction of antigen doses has been implemented. However, these measures may have consequences on the evolution of hepatitis A virus (HAV), leading to the emergence of antigenic variants. Cases in vaccinated MSM patients have been detected in Barcelona, opening the possibility to study HAV evolution under immune pressure. Methods We performed deep-sequencing analysis of ten overlapping fragments covering the complete capsid coding region of HAV. A total of 14578255 reads were obtained and used for the analysis of virus evolution in vaccinated versus non-vaccinated patients. We estimated maximum and minimum mutation frequencies, and Shannon entropy in the quasispecies of each patient. Non-synonymous (NSyn) mutations affecting residues exposed in the capsid surface were located, with respect to epitopes, using the recently described crystal structure of HAV, as an indication of its potential role in escaping to the effect of vaccines. Findings HAV evolution at the quasispecies level, in non-vaccinated and vaccinated patients, revealed higher diversity in epitope-coding regions of the vaccinated group. Although amino acid replacements occurring in and around the epitopes were observed in both groups, their abundance was significantly higher in the quasispecies of vaccinated patients, indicating ongoing processes of fixation. Interpretation Our data suggest positive selection of antigenic variants in some vaccinated patients, raising concerns for new vaccination polices directed to the MSM group.
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Affiliation(s)
- Aurora Sabrià
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Josep Gregori
- Liver Unit, Internal Medicine Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Roche Diagnostics, S.L., Sant Cugat del Vallés, Barcelona, Spain
| | - Damir Garcia-Cehic
- Liver Unit, Internal Medicine Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Guix
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Virology Unit, Microbiology Department, Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Sandra Manzanares-Laya
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp) del Instituto de Salud Carlos III, Madrid, Spain
| | - Joan A Caylà
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEResp) del Instituto de Salud Carlos III, Madrid, Spain
| | - Albert Bosch
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain
| | - Josep Quer
- Liver Unit, Internal Medicine Hospital Vall d'Hebron, Autonomous University of Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) del Instituto de Salud Carlos III, Madrid, Spain.
| | - Rosa M Pintó
- Enteric Virus Laboratory, Department of Genetics, Microbiology and Statistics, School of Biology, Institute of Nutrition and Food Safety, Campus Torribera, University of Barcelona, Barcelona, Spain.
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Geretti AM, Brook G, Cameron C, Chadwick D, French N, Heyderman R, Ho A, Hunter M, Ladhani S, Lawton M, MacMahon E, McSorley J, Pozniak A, Rodger A. British HIV Association Guidelines on the Use of Vaccines in HIV-Positive Adults 2015. HIV Med 2018; 17 Suppl 3:s2-s81. [PMID: 27568789 DOI: 10.1111/hiv.12424] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | | | | | | | | | | | | | | | - Mark Lawton
- Royal Liverpool University Hospital, Liverpool, UK
| | - Eithne MacMahon
- Guy's & St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | | | - Anton Pozniak
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
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19
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Chen GJ, Sun HY, Lin KY, Cheng A, Huang YC, Hsieh SM, Sheng WH, Liu WC, Hung CC, Chang SC. Serological responses to revaccination with hepatitis A virus (HAV) vaccines among HIV-positive individuals whose anti-HAV antibody waned after primary vaccination. Liver Int 2018; 38:1198-1205. [PMID: 29240985 DOI: 10.1111/liv.13665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/05/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Among HIV-positive individuals, seroprotection for hepatitis A virus (HAV) following primary vaccination may wane with time. However, seroresponses to HAV revaccination are rarely investigated among HIV-positive patients who have lost protective antibodies after primary vaccination. METHODS During the outbreak of acute hepatitis A in Taiwan after June 2015, HAV-seronegative, HIV-positive individuals were advised to receive two doses of HAV vaccines at 24 weeks apart. A retrospective 1:2 matched case-control study was conducted to compare the seroresponses at weeks 4, 24, 28 and 48 of HAV vaccination between those who underwent revaccination after having lost protective antibodies (case patients) and those who underwent primary vaccination (controls). RESULTS Seventy-five case patients and 150 matched controls were included. The serological response rates were consistently higher among the case patients than controls: 88.1% vs 10.5% at week 4 following the first dose of HAV vaccination (P < .001); 93.3% vs 46.0% at week 24 (immediately before the second dose; P < .001); 98.7% vs 62.7% at week 28 (4 weeks after the second dose; P < .001) and 98.7% vs 92.7% at week 48 (P = .06). The anti-HAV antibody titres as reflected by the semi-quantitative assay for the case patients were also significantly higher than the controls at weeks 24, 28 and 48 following HAV vaccination. CONCLUSIONS We demonstrated faster and better serological responses to HAV revaccination among the HIV-positive individuals who had lost their anti-HAV antibodies after primary vaccination. Single dose of HAV revaccination may provide rapid and sufficient seroresponses for HAV during the outbreak of acute hepatitis A.
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Affiliation(s)
- Guan-Jhou Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Chia Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Min Hsieh
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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20
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Crum-Cianflone NF, Sullivan E. Vaccinations for the HIV-Infected Adult: A Review of the Current Recommendations, Part I. Infect Dis Ther 2017; 6:303-331. [PMID: 28779442 PMCID: PMC5595780 DOI: 10.1007/s40121-017-0166-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Indexed: 12/19/2022] Open
Abstract
Vaccination is a critical component for ensuring the health of those living with the human immunodeficiency virus (HIV) by protection against vaccine-preventable diseases. Since HIV-infected persons may have reduced immune responses and shorter durations of protection post-vaccination, HIV-specific guidelines have been published by global and national advisory organizations to address these potential concerns. This article provides a comprehensive review of the current guidelines and evidence-based data for vaccinating HIV-infected adults, including guidance on modified vaccine dosing and testing strategies, as well as safety considerations, to enhance protection among this vulnerable population. In the current article, part I of the two-part series, inactivated vaccines with broad indications as well as vaccines for specific risk and age groups will be discussed.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Internal Medicine Department, Scripps Mercy Hospital, San Diego, CA, USA.
- Infectious Disease Division, Scripps Mercy Hospital, San Diego, CA, USA.
- Infectious Disease Division, Naval Medical Center San Diego, San Diego, CA, USA.
| | - Eva Sullivan
- Pharmacy Department, Scripps Mercy Hospital, San Diego, CA, USA
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21
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Lin KY, Chen GJ, Lee YL, Huang YC, Cheng A, Sun HY, Chang SY, Liu CE, Hung CC. Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review. World J Gastroenterol 2017; 23:3589-3606. [PMID: 28611512 PMCID: PMC5449416 DOI: 10.3748/wjg.v23.i20.3589] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/31/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatitis A virus (HAV) is one of the most common infectious etiologies of acute hepatitis worldwide. The virus is known to be transmitted fecal-orally, resulting in symptoms ranging from asymptomatic infection to fulminant hepatitis. HAV can also be transmitted through oral-anal sex. Residents from regions of low endemicity for HAV infection often remain susceptible in their adulthood. Therefore, clustered HAV infections or outbreaks of acute hepatitis A among men who have sex with men and injecting drug users have been reported in countries of low endemicity for HAV infection. The duration of HAV viremia and stool shedding of HAV may be longer in human immunodeficiency virus (HIV)-positive individuals compared to HIV-negative individuals with acute hepatitis A. Current guidelines recommend HAV vaccination for individuals with increased risks of exposure to HAV (such as from injecting drug use, oral-anal sex, travel to or residence in endemic areas, frequent clotting factor or blood transfusions) or with increased risks of fulminant disease (such as those with chronic hepatitis). The seroconversion rates following the recommended standard adult dosing schedule (2 doses of HAVRIX 1440 U or VAQTA 50 U administered 6-12 mo apart) are lower among HIV-positive individuals compared to HIV-negative individuals. While the response rates may be augmented by adding a booster dose at week 4 sandwiched between the first dose and the 6-mo dose, the need of booster vaccination remain less clear among HIV-positive individuals who have lost anti-HAV antibodies.
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22
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Frésard A, Gagneux-Brunon A, Lucht F, Botelho-Nevers E, Launay O. Immunization of HIV-infected adult patients - French recommendations. Hum Vaccin Immunother 2016; 12:2729-2741. [PMID: 27409293 PMCID: PMC5137523 DOI: 10.1080/21645515.2016.1207013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/25/2016] [Accepted: 06/24/2016] [Indexed: 02/06/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients remain at increased risk of infection including vaccine-preventable diseases. Vaccines are therefore critical components in the protection of HIV-infected patients from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected patients persist and vaccine coverage in this population could be improved. This article presents the French recommendations regarding immunization of HIV-infected adults in the light of the evidence-based literature on the benefits and the potential risks of vaccines among this vulnerable population.
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Affiliation(s)
- Anne Frésard
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
| | - Frédéric Lucht
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Elisabeth Botelho-Nevers
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Etienne, France
- Inserm, CIC 1408, St-Etienne, France
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
| | - Odile Launay
- Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France
- Inserm, CIC 1417, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Department of Infectious Diseases, CIC Cochin Pasteur, Paris, France
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23
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CD4/CD8 Ratio Predicts Yellow Fever Vaccine-Induced Antibody Titers in Virologically Suppressed HIV-Infected Patients. J Acquir Immune Defic Syndr 2016; 71:189-95. [PMID: 26361176 DOI: 10.1097/qai.0000000000000845] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Yellow fever vaccine (YFV) induces weaker immune responses in HIV-infected individuals. However, little is known about YFV responses among antiretroviral-treated patients and potential immunological predictors of YFV response in this population. METHODS We enrolled 34 antiretroviral therapy (ART)-treated HIV-infected and 58 HIV-uninfected adults who received a single YFV dose to evaluate antibody levels and predictors of immunity, focusing on CD4(+) T-cell count, CD4(+)/CD8(+) ratio, and Human Pegivirus (GBV-C) viremia. Participants with other immunosuppressive conditions were excluded. RESULTS Median time since YFV was nonsignificantly shorter in HIV-infected participants than in HIV-uninfected participants (42 and 69 months, respectively, P = 0.16). Mean neutralizing antibody (NAb) titers was lower in HIV-infected participants than HIV-uninfected participants (3.3 vs. 3.6 log10mIU/mL, P = 0.044), a difference that remained significant after adjustment for age, sex, and time since vaccination (P = 0.024). In HIV-infected participants, lower NAb titers were associated with longer time since YFV (rho: -0.38, P = 0.027) and lower CD4(+)/CD8(+) ratio (rho: 0.42, P = 0.014), but not CD4(+) T-cell count (P = 0.52). None of these factors were associated with NAb titers in HIV-uninfected participant. GBV-C viremia was not associated with difference in NAb titers overall or among HIV-infected participants. CONCLUSIONS ART-treated HIV-infected individuals seem to have impaired and/or less durable responses to YFV than HIV-uninfected individuals, which were associated with lower CD4(+)/CD8(+) ratio, but not with CD4(+) T-cell count. These results supports the notion that low CD4(+)/CD8(+) ratio, a marker linked to persistent immune activation, is a better indicator of functional immune disturbance than CD4(+) T-cell count in patients with successful ART.
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24
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Epidemiology of sexually transmitted viral hepatitis in human immunodeficiency virus-positive men who have sex with men in Asia. J Formos Med Assoc 2015; 114:1154-61. [PMID: 26375778 DOI: 10.1016/j.jfma.2015.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/02/2015] [Accepted: 08/11/2015] [Indexed: 01/10/2023] Open
Abstract
Both human immunodeficiency virus (HIV) and viral hepatitis constitute major disease burden globally. As with other parts of the world, the HIV epidemic in Asia impacts mainly on men who have sex with men, one of the at-risk populations for sexually transmitted viral hepatitis. With the increasing availability of effective antiretroviral therapy, HIV-related mortality of people living with HIV has markedly reduced. Liver disease has become an important cause of mortality and morbidity in the HIV-infected population. With the improvement of socioeconomic conditions and availability of healthcare in Asian countries in recent years, the epidemiology of sexually transmitted viral hepatitis among HIV-positive men who have sex with men has also evolved. This review updates the epidemiology of different types of sexually transmitted viral hepatitis in this defined population in Asia.
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25
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Abstract
Hepatitis B and A account for considerable morbidity and mortality worldwide. Immunization is the most effective means of preventing hepatitis B and A. However, the immune response to both hepatitis vaccines seems to be reduced in HIV-infected subjects. The aim of this review was to analyze the immunogenicity, safety, long-term protection and current recommendations of hepatitis B and A vaccination among HIV-infected adults. The factors most frequently associated with a deficient level of anti-HBs or IgG anti-HAV after vaccination are those related to immunosuppression (CD4 level and HIV RNA viral load) and to the frequency of administration and/or the amount of antigenic load per dose. The duration of the response to both HBV and HAV vaccines is associated with suppression of the viral load at vaccination and, in the case of HBV vaccination, with a higher level of antibodies after vaccination. In terms of safety, there is no evidence of more, or different, adverse effects compared with HIV-free individuals. Despite literature-based advice on the administration of alternative schedules, revaccination after the failure of primary vaccination, and the need for periodic re-evaluation of antibody levels, few firm recommendations are found in the leading guidelines.
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Affiliation(s)
- G Mena
- a Department of Preventive Medicine & Care Quality ; Hospital General Universitario de Castellón ; Castellón de la Plana , Spain
| | - A L García-Basteiro
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,c Centro de Investigação em Saúde deg Manhiça (CISM) ; Manhiça, Maputo , Mozambique
| | - J M Bayas
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,d Department of Preventive Medicine & Epidemiology ; Hospital Clínic de Barcelona; Universitat de Barcelona ; Barcelona , Spain
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26
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Gouvêa ADFTB, Pinto MIDM, Miyamoto M, Machado DM, Pessoa SD, Carmo FBD, Beltrão SCDV, Succi RCDM. [Persistence of hepatitis A virus antibodies after primary immunization and response to revaccination in children and adolescents with perinatal HIV exposure]. REVISTA PAULISTA DE PEDIATRIA 2015; 33:142-9. [PMID: 25918013 PMCID: PMC4516366 DOI: 10.1016/j.rpped.2014.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE: To assess possible factors associated with the loss of antibodies to hepatitis A
7 years after the primary immunization in children of HIV-infected mothers and the
response to revaccination in patients seronegative for hepatitis A. METHODS: Quantification of HAV antibodies by electrochemiluminescence was performed in 39
adolescents followed up at the Pediatric Aids Clinic of Federal University of São
Paulo (Unifesp): 29 HIV-infected (HIV group) (median age: 12.8 years) and 10
HIV-exposed but non-infected (ENI group) (median age: 13.4 years). All of them
received two doses of HAV vaccine (Havrix(r)) in 2002. RESULTS: The median age at primary immunization (PI) was 5.4 years for HIV group and 6.5
years for ENI group. All children, from both groups, had antibodies to HAV >20
mIU/mL after PI. Seven years later, the ENI group showed a median concentration of
antibodies = 253.5 mIU/mL, while the HIV group = 113.0 mIU/mL (Mann-Whitney test,
p=0.085). All ENI group and 23/29 (79.3%) from HIV group
mantained HAV antibodies 7 years after PI. The levels of hepatitis A antibodies in
the primary vaccination were the only factor independently associated with
maintaining these antibodies for 7 years. The group that lost HAV seropositivity
was revaccinated and 83.3% (5/6) responded with antibodies >20 mUI/mL. CONCLUSIONS: The antibodies levels acquired in the primary vaccination in the HIV group were
the main factor associated with antibodies loss after HAV immunization.
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Affiliation(s)
| | | | - Maristela Miyamoto
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, SP, Brasil
| | - Daisy Maria Machado
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, SP, Brasil
| | - Silvana Duarte Pessoa
- Ambulatório de Infectologia Pediátrica do Centro de Referência de DST/Aids (CR DST/Aids) do Município de Diadema e do Serviço de Atendimento Especializado (SAE), Diadema, SP, Brasil
| | - Fabiana Bononi do Carmo
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, SP, Brasil
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27
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Garcia Garrido HM, Wieten RW, Grobusch MP, Goorhuis A. Response to Hepatitis A Vaccination in Immunocompromised Travelers. J Infect Dis 2015; 212:378-85. [PMID: 25649170 DOI: 10.1093/infdis/jiv060] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/26/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hepatitis A vaccines are highly immunogenic in healthy patients, but there is uncertainty about their immunogenicity in immunocompromised patients. METHODS Our study included immunocompromised patients who received 1 or 2 hepatitis A vaccinations between January 2011 and June 2013. We assessed factors that influenced the serologic response to vaccination. We performed a literature review of previous studies on hepatitis A vaccination in immunocompromised patients. RESULTS Of 85 immunocompromised patients, 65 used immunosuppressive drugs, 13 had received stem cell transplants, and 7 were infected with human immunodeficiency virus. After vaccination, 65 of 85 (76.5%) developed antibodies. Tumor necrosis factor α blocker use was associated with better serologic responses than other immunosuppressive drugs. Female patients were more compliant than male patients with postvaccination antibody titer measurements. In 11 relevant studies, antibody responses after the first and second vaccination averaged 37% and 82%, respectively. Factors that negatively influenced serologic response rates were high doses of immunosuppressive drugs, fewer hepatitis A vaccinations, and a short interval between vaccination and antibody measurement. CONCLUSIONS Immunocompromised patients showed moderate to good serologic responses to hepatitis A vaccination, but may need more time to develop immunity. Tumor necrosis factor α blocker use was associated with better antibody responses than other drugs. Specifically, male patients should be motivated to return for antibody titer measurements.
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Affiliation(s)
- Hannah M Garcia Garrido
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Rosanne W Wieten
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Abraham Goorhuis
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
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Abstract
Vaccines are critical components for protecting HIV-infected adults from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected persons persist, likely due to concerns regarding the safety and efficacy of vaccines, as well as the changing nature of vaccine guidelines. In addition, the optimal timing of vaccination among HIV-infected adults in regards to HIV stage and receipt of antiretroviral therapy remain important questions. This article provides a review of the current recommendations regarding vaccines among HIV-infected adults and a comprehensive summary of the evidence-based literature of the benefits and risks of vaccines among this vulnerable population.
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Affiliation(s)
- Nancy F. Crum-Cianflone
- Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, California
- Department of Infectious Disease, Scripps Mercy Hospital, San Diego, California
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29
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Durability of a vesicular stomatitis virus-based marburg virus vaccine in nonhuman primates. PLoS One 2014; 9:e94355. [PMID: 24759889 PMCID: PMC3997383 DOI: 10.1371/journal.pone.0094355] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/14/2014] [Indexed: 01/14/2023] Open
Abstract
The filoviruses, Marburg virus (MARV) and Ebola virus, causes severe hemorrhagic fever with high mortality in humans and nonhuman primates. A promising filovirus vaccine under development is based on a recombinant vesicular stomatitis virus (rVSV) that expresses individual filovirus glycoproteins (GPs) in place of the VSV glycoprotein (G). These vaccines have shown 100% efficacy against filovirus infection in nonhuman primates when challenge occurs 28–35 days after a single injection immunization. Here, we examined the ability of a rVSV MARV-GP vaccine to provide protection when challenge occurs more than a year after vaccination. Cynomolgus macaques were immunized with rVSV-MARV-GP and challenged with MARV approximately 14 months after vaccination. Immunization resulted in the vaccine cohort of six animals having anti-MARV GP IgG throughout the pre-challenge period. Following MARV challenge none of the vaccinated animals showed any signs of clinical disease or viremia and all were completely protected from MARV infection. Two unvaccinated control animals exhibited signs consistent with MARV infection and both succumbed. Importantly, these data are the first to show 100% protective efficacy against any high dose filovirus challenge beyond 8 weeks after final vaccination. These findings demonstrate the durability of VSV-based filovirus vaccines.
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30
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Jabłonowska E, Kuydowicz J. Durability of response to vaccination against viral hepatitis A in HIV-infected patients: a 5-year observation. Int J STD AIDS 2014; 25:745-50. [PMID: 24452731 DOI: 10.1177/0956462413518902] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this study was to estimate the prevalence of total antibodies to hepatitis A virus (anti-HAV-T) in the group of HIV-positive adults in Lodz region of Poland, and to evaluate the response and long-term immunity after vaccination against hepatitis A virus. In the group of 234 HIV-infected patients, 72 persons (30.8%) were anti-HAV-T positive (>20 IU/L). In multivariate analysis, two independent factors associated with the presence of anti-HAV-T were identified: the age of patients (OR = 1.07) and the presence of antibodies to hepatitis C virus (OR = 2.87). Vaccination was completed in 83 patients. Good response (anti-HAV-T >20 IU/L one month after the booster dose) was obtained in 79.5% of patients. In patients with CD4 >200 cells/µL in multivariate analysis only presence of antibodies to hepatitis C virus was a prognostic factor for the response to vaccination (OR = 0.13). Among responders available for the follow-up, 82% (50 out of 61) had detectable anti-HAV-T at 1 year and 75.5% (37 out of 49) at 5 years. Our results demonstrate that most of the studied HIV-positive patients were susceptible to hepatitis A virus infection. Most HIV-infected adults with high CD4 counts had a durable response even up to 5 years after vaccination. Patients with a HIV/hepatitis C virus coinfection displayed a worse response to vaccination.
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Affiliation(s)
- E Jabłonowska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
| | - J Kuydowicz
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland
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Kernéis S, Launay O, Turbelin C, Batteux F, Hanslik T, Boëlle PY. Long-term immune responses to vaccination in HIV-infected patients: a systematic review and meta-analysis. Clin Infect Dis 2014; 58:1130-9. [PMID: 24415637 DOI: 10.1093/cid/cit937] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Vaccine-induced antibodies may wane more quickly in persons living with human immunodeficiency virus (HIV) than in healthy individuals. We reviewed the literature on vaccines routinely recommended in HIV-infected patients to estimate how seroprotection decreases over time in those who initially responded to immunization. For each study retrieved from the literature, the decrease of seroprotection was modeled with a log binomial generalized linear model, and data were pooled in a meta-analysis to provide estimates of seroprotection 2 and 5 years after the last vaccine administration. Our analyses confirmed that the duration of seroprotection was shorter in HIV-infected patients and that with current guidelines, a substantial proportion of patients would have lost protective antibodies before a booster was proposed. We therefore discuss the implications for the monitoring of antibody levels and timing of revaccination in these patients.
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Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11:217-29. [DOI: 10.1071/sh14003] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/09/2014] [Indexed: 01/07/2023]
Abstract
Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.
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Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2013; 58:e44-100. [PMID: 24311479 DOI: 10.1093/cid/cit684] [Citation(s) in RCA: 543] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
An international panel of experts prepared an evidenced-based guideline for vaccination of immunocompromised adults and children. These guidelines are intended for use by primary care and subspecialty providers who care for immunocompromised patients. Evidence was often limited. Areas that warrant future investigation are highlighted.
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Affiliation(s)
- Lorry G Rubin
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York of the North Shore-LIJ Health System, New Hyde Park
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Kourkounti S, Papaizos V, Leuow K, Kordosis T, Antoniou C. Hepatitis A Vaccination and Immunological Parameters in HIV-Infected Patients. Viral Immunol 2013; 26:357-63. [DOI: 10.1089/vim.2012.0100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sofia Kourkounti
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
| | - Vassilios Papaizos
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
| | - Kirsten Leuow
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
| | - Theodoros Kordosis
- Department of Pathophysiology (AIDS Unit), Laikon General Hospital, Athens, Greece
| | - Christina Antoniou
- Department of Dermatology and Venereology (AIDS Unit), A. Sygros Hospital, Athens, Greece
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Mena G, García-Basteiro AL, Llupià A, Díez C, Costa J, Gatell JM, García F, Bayas JM. Factors associated with the immune response to hepatitis A vaccination in HIV-infected patients in the era of highly active antiretroviral therapy. Vaccine 2013; 31:3668-74. [PMID: 23777950 DOI: 10.1016/j.vaccine.2013.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/26/2013] [Accepted: 06/04/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION HIV seropositivity is considered a risk factor for complications in hepatitis A virus (HAV) infection. HAV vaccination schedules are widely implemented in HIV-infected patients, but the immune response remains impaired. METHODS We analysed the response to vaccination (antiHAV titres ≥20IU/l) in 282 HIV-infected patients included in a standard (1440 Elisa Units (EU) at 0, 6 months) or rapidly accelerated schedule (720 EU at 0, 7, 21 days and 6 months) between 1997 and 2009. Factors associated with the response to vaccination were analysed using logistic regression. RESULTS The overall response rate was 73.4%. Male sex (OR: 0.16, 95% CI 0.05-0.51) and hepatitis C virus co-infection (OR: 0.30, 95% CI 0.14-0.74) were associated with a lower probability of response. Protective antibody response was associated with a higher CD4/CD8 ratio (OR: 3.69, 95% CI 1.3-10.5) and having received two doses of standard schedule (compared with patients receiving only one dose of the same schedule) (OR: 2.51, 95% CI 1.22-5.15). Three doses of the rapidly accelerated schedule were not more effective than a single dose of 1440 EU (OR: 1.32, 95% CI 0.48-3.63). CONCLUSION The low responses observed in patients receiving a single dose suggest the need to emphasize adhesion to vaccination protocols to avoid failure. The CD4/CD8 ratio may be considered as an immune status marker which could help to better choose the moment of vaccination. Our findings underscore the importance of identifying strategies that optimize the timing and effectiveness of hepatitis A vaccination in HIV-infected patients and of the need for further studies on individual factors such as sex and hepatitis C co-infection that may affect the response to vaccination. Likewise, the sub-optimal effectiveness of three doses of 720 EU in the rapidly accelerated schedule, if confirmed in future studies, might lead to a revision of the current schedule recommended for HIV-infected travellers.
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Affiliation(s)
- Guillermo Mena
- Preventive Medicine and Epidemiology Unit, Hospital Clínic, Barcelona, Spain.
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Tseng YT, Chang SY, Liu WC, Sun HY, Wu CH, Wu PY, Lu CL, Hung CC, Chang SC. Comparative effectiveness of two doses versus three doses of hepatitis A vaccine in human immunodeficiency virus-infected and -uninfected men who have sex with men. Hepatology 2013; 57:1734-41. [PMID: 23258666 DOI: 10.1002/hep.26210] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 12/09/2012] [Indexed: 01/10/2023]
Abstract
UNLABELLED The purpose of this prospective cohort study was to compare the serologic response between human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) receiving two and three doses of hepatitis A virus (HAV) vaccine and HIV-uninfected MSM receiving two doses of HAV vaccine. Between June 2009 and December 2010, 582 MSM aged 18 to 40 years who were seronegative for HAV were enrolled in the study. HIV-infected MSM received either two doses of HAV vaccine (1,440 enzyme-linked immunosorbent assay units) (n = 140) with the second dose given at week 24 or three doses (n = 225) with the second and third dose given at weeks 4 and 24, respectively, while HIV-uninfected MSM (n = 217) received two doses. The primary endpoint was seroconversion at week 48. The geometric mean concentration (GMC) of anti-HAV antibody was determined at weeks 48 and 72. At week 48, the seroconversion rate was 75.7%, 77.8%, and 88.5% in intention-to-treat analysis for two-dose HIV-infected, three-dose HIV-infected, and two-dose HIV-uninfected MSM, respectively. The GMC of anti-HAV antibody at week 48 for three-dose HIV-infected MSM (2.29 ± 0.73 log10 mIU/mL) was significantly higher than that for two-dose HIV-infected MSM (1.94 ± 0.66; P < 0.01), but was lower than HIV-uninfected MSM (2.49 ± 0.42; P < 0.01). Multivariate analysis revealed higher CD4 counts (adjusted odds ratio [AOR] for per 50 cells/μL increase, 1.13; 95% confidence interval [CI], 1.05-1.21) and undetectable plasma HIV RNA load (AOR, 1.90; 95% CI, 1.10-3.28) before HAV vaccination were predictive of seroconversion in HIV-infected patients. CONCLUSION Serologic response rate to three and two doses of HAV vaccine was similar in HIV-infected MSM, which was lower than that in HIV-uninfected MSM receiving two doses. HAV vaccination in HIV-infected patients with a higher CD4 count and suppression of HIV replication increased the seroconversion rate.
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Affiliation(s)
- Yu-Tzu Tseng
- Departments of Traumatology, National Taiwan University College of Medicine, Taipei, Taiwan
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Kourkounti S, Mavrianou N, Paparizos VA, Kyriakis K, Hatzivassiliou M, Kordosis T, Katsambas A. Immune response to hepatitis A vaccination in HIV-infected men in Greece. Int J STD AIDS 2013; 23:464-7. [PMID: 22843998 DOI: 10.1258/ijsa.2011.011297] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
HIV-infected patients are at increased risk for acquiring hepatitis A virus (HAV) infection. We evaluated the seroconversion rate (anti-HAV antibodies ≥ 20 mIU/ml) and the geometric mean antibody titres (GMTs) in a group of 351 HIV infected men, who had received two doses of a hepatitis A vaccine. We analysed blood samples collected at one, six, 12 and 18 months following the administration of the second dose of the vaccine. The seroconversion rate one month after the second dose of the vaccine was 74.4% (260/351). At month 18 after the end of vaccination, 56.1% of the subjects remained seropositive. GMTs were 315, 203, 153 and 126 mIU/ml at months 1, 6, 12, and 18, respectively. Logistic regression revealed that the CD4 count is the only factor affecting response to vaccination (P = 0.019). A higher response rate and higher GMTs were observed in patients with CD4 counts ≥ 500 cells/mm(3) (76.6%) than in patients with CD4 counts 200-499 cells/mm(3). In conclusion, even in patients with near-normal CD4 counts, the response to the hepatitis A vaccine is impaired.
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Affiliation(s)
- S Kourkounti
- Department of Dermatology and Venereology, (AIDS Unit) 'A. Sygros' Hospital, Greece.
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Abstract
This article reviews the normal immune response to vaccines. It describes the effect of different immunosuppressive therapies (glucocorticoids, inhibitors of calcineurin and mTOR, azathioprine, mycophenolate acid, methotrexate, depleting and nondepleting monoclonal antibodies, and tumor necrosis factor antagonists) on critical steps in the cellular and humoral immune responses to vaccines. The impact of age-related involution of thymus and bone marrow on the immune reconstitution in allogeneic hematopoietic cell transplant recipients and human immunodeficiency virus is covered. A practical approach to vaccinating and preparing travelers with severe immunosuppression is proposed.
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Affiliation(s)
- L G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands.
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Advances in hepatitis immunization (A, B, E): public health policy and novel vaccine delivery. Curr Opin Infect Dis 2012; 25:578-83. [PMID: 22907280 DOI: 10.1097/qco.0b013e328357e65c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review offers an update on hepatitis A, B and E vaccines based on relevant literature published in 2011-2012. Hepatitis A and B vaccines have been commercially available for years; however, the development of the hepatitis E vaccine is still facing some challenges. RECENT FINDINGS Current scientific evidence shows that both hepatitis A and B vaccines confer long-term protection. These data supported the updated recommendations from the WHO on hepatitis A and B vaccines and the respective booster policy. In addition, a single-dose hepatitis A vaccination programme may be an option for some intermediate endemic countries, as far as the epidemiological situation is further monitored. Recent data illustrate the co-administration of hepatitis A with infant vaccines, as well as the interchangeability with other hepatitis A vaccines. Two genetically engineered hepatitis E vaccines are currently in development, showing more than 95% protective efficacy. SUMMARY Follow-up of vaccinated individuals confirms the long-term protection offered by the hepatitis A as well as hepatitis B vaccines. Data confirm the safety and immunogenicity profile of both vaccines, also when used in patient groups. The first data on the hepatitis E vaccine look promising, but questions on cross-protection, long-term efficacy and safety and immunogenicity in pregnant women and children less than 2 years remain unanswered.
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Determinants of hepatitis A vaccine immunity in a cohort of human immunodeficiency virus-infected children living in Switzerland. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1751-7. [PMID: 22933400 DOI: 10.1128/cvi.00264-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Vaccination in HIV-infected children is often less effective than in healthy children. The goal of this study was to assess vaccine responses to hepatitis A virus (HAV) in HIV-infected children. Children of the Swiss Mother and Child HIV Cohort Study (MoCHiV) were enrolled prospectively. Recommendations for initial, catch-up, and additional HAV immunizations were based upon baseline antibody concentrations and vaccine history. HAV IgG was assessed by enzyme-linked immunosorbent assay (ELISA) with a protective cutoff value defined as ≥10 mIU/ml. Eighty-seven patients were included (median age, 11 years; range, 3.4 to 21.2 years). Forty-two patients were seropositive (48.3%) for HAV. Among 45 (51.7%) seronegative patients, 36 had not received any HAV vaccine dose and were considered naïve. Vaccine responses were assessed after the first dose in 29/35 naïve patients and after the second dose in 33/39 children (25 initially naïve patients, 4 seronegative patients, and 4 seropositive patients that had already received 1 dose of vaccine). Seroconversion was 86% after 1 dose and 97% after 2 doses, with a geometric mean concentration of 962 mIU/ml after the second dose. A baseline CD4(+) T cell count below 750 cells/μl significantly reduced the post-2nd-dose response (P = 0.005). Despite a high rate of seroconversion, patients with CD4(+) T cell counts of <750/μl had lower anti-HAV antibody concentrations. This may translate into a shorter protection time. Hence, monitoring humoral immunity may be necessary to provide supplementary doses as needed.
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Responses to hepatitis A virus vaccine in HIV-infected women: effect of hormonal contraceptives and HIV disease characteristics. J Acquir Immune Defic Syndr 2012; 60:e15-8. [PMID: 22517417 DOI: 10.1097/qai.0b013e31824d30bd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Ott JJ, Irving G, Wiersma ST. Long-term protective effects of hepatitis A vaccines. A systematic review. Vaccine 2012; 31:3-11. [PMID: 22609026 DOI: 10.1016/j.vaccine.2012.04.104] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/26/2012] [Accepted: 04/28/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Data on duration and long-term protective effects of hepatitis A vaccines (HepA) have not been reviewed using a systematic approach. Our objective is to provide a comprehensive review of evidence on the duration of protection achieved by HepA, which is needed for revising existing vaccine policies. Limitations in data availability and implications for future research in this area are discussed. METHODS A systematic literature review was conducted including all studies published between 1997 and 2011 reporting on long-term protection of HepA. The outcomes considered were hepatitis A virus (HAV) infection and sero-protection measured by anti-HAV antibodies after follow-up times of over 5 years post-vaccination. RESULTS 299 studies were identified from MEDLINE and 51 studies from EMBASE. 13 manuscripts met our inclusion criteria. The maximum observation times and reported persistence levels of sero-protective anti-HAV antibodies was 15 years for live attenuated HepA and 14 years for inactivated HepA. All data were from observational studies and showed that higher number of doses of live attenuated vaccine led to higher seropositivity and GMT, but dosage and schedule did not significantly impact the long-term protection following inactivated vaccine. Few comparisons were made between the two vaccine types indicating highest levels of antibody titers achieved by multiple doses of live attenuated vaccines 7 years post-vaccination. CONCLUSION Available data indicate that both inactivated and live attenuated HepA are capable of providing protection up to 15 years as defined by currently accepted, conservative correlates of protection. Further investigations are needed to continue to monitor the long-term protection afforded by these vaccines. Standardized methods are required for vaccine-follow-up studies including assessment of co-variables potentially affecting long-term protection.
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Clinical and laboratory characteristics of human immunodeficiency virus-infected adolescents: experience from a single medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:329-36. [PMID: 22578644 DOI: 10.1016/j.jmii.2011.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 07/14/2011] [Accepted: 08/25/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recently, the proportion of adolescents diagnosed with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has increased. The aim of this study is to evaluate the clinical and laboratory characteristics of HIV-infected adolescents in southern Taiwan. METHODS From June 1997 to December 2010, a total of 40 HIV-infected adolescents who sought medical care in a university hospital in southern Taiwan were enrolled in the study. They were classified into three HIV at-risk groups, men who have sex with men (MSM), heterosexuals, and intravenous drug users (IDUs). Clinical and laboratory data were obtained from medical records. RESULTS The median age of the 40 HIV-infected adolescents was 19 years. The HIV at-risk groups were MSM (22/40, 55%), heterosexuals (7/40, 17.5%), IDUs (5/40, 12.5%), and unknown (6/40, 15%). The initial median CD4 count and log plasma HIV viral load were 318 cells/mm(3) and 4.61, respectively. The seroprevalence of anti-HAV, anti-HBc, anti-HCV antibodies and HBsAg was 5.3%, 26.1%, 13% and 13%, respectively. Among 17 adolescents who had regular follow-ups more than twice, 7 (41.2%) had a concurrent sexually transmitted disease (STD). The most common STD was genital warts (41.2%) followed by syphilis (11.8%). Among 7 patients who received highly active antiretroviral agents (HAART) for more than 12 months, 5 (71.4%) had sustained virologic suppression. CONCLUSION MSM are the largest risk group in HIV-infected adolescents in southern Taiwan and are characterized by a high prevalence of anogenital warts and low seroprevalence of anti-HAV.
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Phung BC, Launay O. Vaccination against viral hepatitis of HIV-1 infected patients. Hum Vaccin Immunother 2012; 8:554-9. [PMID: 22634451 DOI: 10.4161/hv.19105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Reciprocal interactions between HIV and HAV or HBV can increase risk of morbidity and mortality in HIV disease and/or worsened the natural course of the hepatitis viruses. Hepatitis A vaccination is recommended for HIV infected patients at risk for exposure or severe disease: men who have sex with men, injecting drug users, patients with chronic liver disease and patients traveling in high endemic countries. As for healthy adults the scheme of vaccination is two doses 6 or 12 mo apart, nevertheless, seroconversion rates are lower. A third dose could improve the seroconversion rates. Hepatitis B vaccination is recommended for all HIV infected persons lacking prior immunity. As the immune response to hepatitis B vaccines is impaired in HIV-infected adults, four double doses of hepatitis B vaccine could enhance serological response. To assume a higher immune response, vaccines should be administered in HIV-infected patients with undetectable HIV viral load and high CD4 cell count.
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Affiliation(s)
- Bao-Chau Phung
- Université Paris Descartes, Faculté de Médicine, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, CIC de Vaccinologie Cochin Pasteur, Inserm, CIC BT505, Paris, France
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Lugoboni F, Pajusco B, Albiero A, Quaglio G. Hepatitis A Virus among Drug Users and the Role of Vaccination: A Review. Front Psychiatry 2011; 2:79. [PMID: 22347865 PMCID: PMC3276338 DOI: 10.3389/fpsyt.2011.00079] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 12/26/2011] [Indexed: 12/11/2022] Open
Abstract
In countries with advanced economies better health and hygiene conditions, along with the introduction, in some cases, of global vaccination, have relegated most viral hepatitis to marginal social groups and, in particular, drug users (DUs). The availability of safe and effective vaccines for hepatitis A virus (HAV) and B (HBV) may play a major role in combating this phenomenon. Despite the availability of a safe and effective vaccine for over a decade and the recommendations of international health organizations, vaccinations against HAV among DUs are not as widely known and available as are HBV vaccinations. The purpose of this review article is to present the most significant data in the literature on the prevalence of HAV among DUs and the role of targeted vaccination. To our knowledge, the present article is the first to solely deal with vaccination against HAV in DUs. Immunization after the administration of anti-HAV vaccine has been demonstrated in DUs even if they have responded significantly less than either the general population or carriers of chronic liver disease. All the vaccines were well tolerated and adherence to the vaccine schedule was good. Further studies are needed to optimize the timing and doses of vaccine to be administered to DUs, especially to assess adherence and antibody persistence. Vaccination campaigns are feasible among DUs and have proven to be highly cost-effective.
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Affiliation(s)
- Fabio Lugoboni
- Addiction Unit, Department of Internal Medicine, Verona University Hospital Verona, Italy
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