1
|
Vargas JI, Jensen D, Martínez F, Sarmiento V, Peirano F, Acuña P, Provoste F, Bustos V, Cornejo F, Fuster A, Acuña M, Fuster F, Soto S, Estay D, Jensen W, Ahumada R, Arab JP, Soza A, Fuster F. Comparative Efficacy of a High-Dose vs Standard-Dose Hepatitis B Revaccination Schedule Among Patients With HIV: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2120929. [PMID: 34424307 PMCID: PMC8383137 DOI: 10.1001/jamanetworkopen.2021.20929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Active immunization for hepatitis B virus (HBV) infection is recommended in patients living with HIV. Limited evidence is available about the most appropriate regimen of HBV vaccination among those who have not responded to an initial schedule. OBJECTIVE To determine the efficacy of a high-dose schedule compared with a standard dose of HBV vaccination. DESIGN, SETTING, AND PARTICIPANTS This double-masked, parallel-group, randomized controlled trial included patients living with HIV at a single outpatient HIV and hepatology clinic in Chile for whom previous HBV vaccination had failed. Patients with hepatitis B surface antibody (anti-HBs) titers less than 10 IU/L after an initial HBV vaccination regimen were included. Consecutive patients were recruited between December 2013 and March 2018. Data were analyzed in June 2018 using intention-to-treat analysis. INTERVENTION The high-dose HBV vaccination group consisted of 3 doses of 40 μg recombinant hepatitis B vaccine at 0, 1, and 2 months. The standard-dose group received 3 doses 20 μg each at 0, 1, and 2 months. MAIN OUTCOMES AND MEASURES Primary outcome was the serologic response to HBV vaccination (anti-HBs greater than 10 IU/L) 4 to 8 weeks after completion of the schedule. Secondary outcomes were anti-HBs greater than 100 IU/L and seroprotective anti-HBs at 1 year follow up. RESULTS A total of 107 patients underwent randomization (55 to the standard-dose group, 52 to the high-dose group); 81 (75.7%) were men, and the mean (SD) patient age was 47.0 (13.3) years. Nearly all patients were receiving antiretroviral therapy (105 patients [98%]) and 92 patients (86%) had an undetectable HIV viral load. Mean (SD) CD4 count was 418 (205) cells/mm3. There were no differences in baseline characteristics between groups. Serological response in the high-dose group was found in 36 of 50 patients (72%; 95% CI, 56.9%-82.9%) compared with 28 of 55 patients in the standard-dose group (51%; 95% CI, 37.1%-64.6%) (odds ratio, 2.48; 95% CI, 1.02-6.10; P = .03). Mean (SD) anti-HB levels were 398.0 (433.4) IU/L in the high-dose group and 158.5 (301.4) IU/L in the standard-dose group (P < .001). Of patients with a serological response in the high-dose group, 29 of 36 (80.6%) had anti-HBs titers greater than 100 IU/L compared with 14 of 28 responders (50.0%) in the standard-dose group (P = .02). At 1-year follow-up, 20 of 25 patients (80.0%) with a serological response in the high-dose group had protective anti-HBs vs 9 of 23 patients (39.1%) in the standard-dose group (P = .01). CONCLUSIONS AND RELEVANCE The results of this randomized clinical trial suggest that use of a high-dose regimen for HBV revaccination for patients with HIV achieves a higher and longer-lasting serological response as compared with a standard-dose regimen. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02003703.
Collapse
Affiliation(s)
- Jose Ignacio Vargas
- Hepatology Unit, Hospital Gustavo Fricke, Viña del Mar, Chile
- Gastroenterology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniela Jensen
- Hepatology Unit, Hospital Gustavo Fricke, Viña del Mar, Chile
- Internal Medicine and Endocrinology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Felipe Martínez
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Sede Viña del Mar, Viña del Mar
| | | | - Felipe Peirano
- Internal Medicine and Endocrinology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
- Facultad de Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar
| | - Pedro Acuña
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Sede Viña del Mar, Viña del Mar
| | - Felipe Provoste
- Facultad de Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar
| | - Valentina Bustos
- Internal Medicine and Endocrinology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
- Facultad de Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar
| | - Francisca Cornejo
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Sede Viña del Mar, Viña del Mar
| | - Antonieta Fuster
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Sede Viña del Mar, Viña del Mar
| | - Martin Acuña
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Sede Viña del Mar, Viña del Mar
| | - Felipe Fuster
- Facultad de Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar
| | | | - Denisse Estay
- Hepatology Unit, Hospital Gustavo Fricke, Viña del Mar, Chile
- Infectious Disease Unit, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Werner Jensen
- Infectious Disease Unit, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Rodrigo Ahumada
- Infectious Disease Unit, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Juan Pablo Arab
- Gastroenterology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Soza
- Gastroenterology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | |
Collapse
|
2
|
Lee JH, Hong S, Im JH, Lee JS, Baek JH, Kwon HY. Systematic review and meta-analysis of immune response of double dose of hepatitis B vaccination in HIV-infected patients. Vaccine 2020; 38:3995-4000. [PMID: 32334887 DOI: 10.1016/j.vaccine.2020.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The prevalence of co-infection of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is high and increases risk of hepatitis B chronicity and mortality. Despite guidelines for HIV-infected patients to be immunized against HBV, the immunogenicity of the HBV vaccination in HIV-infected patients is lower than that in the HIV-seronegative population. METHOD In this study, we performed a systematic review of the literature and meta-analysis of randomized clinical trials to investigate the response rate to an increased dose of HBV vaccination in HIV-infected patients. A fixed-effects model, with heterogeneity and sensitivity analyses, was used. We identified nine studies involving 970 HIV-positive vaccine recipients. RESULTS The study results were divided into two groups, depending on the time when antibody against hepatitis surface antigen was measured. Results showed a significant increase in response rates among patients who received a double dose of the vaccine versus the standard dose in both subgroups; the pooled odds ratio (OR) was 1.76 (95% confidence interval [CI]: 1.36-2.29) and 2.28 (95% CI: 1.73-3.01) for the rate that was measured 4-6 weeks and >12 months after completion of vaccination, respectively. The total OR was 1.99 (95% CI: 1.64-2.41). No heterogeneity was found. DISCUSSION Our meta-analysis shows that a double dose of the HBV vaccine may significantly improve the immune response in HIV-infected patients. Higher immunogenicity was observed, when it was measured 4-6 weeks and >12 months after completion of the vaccination.
Collapse
Affiliation(s)
- Jung-Hwan Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
| | - Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
| | - Hea Yoon Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
| |
Collapse
|
3
|
Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1. THE LANCET. INFECTIOUS DISEASES 2013; 12:966-76. [PMID: 23174382 DOI: 10.1016/s1473-3099(12)70243-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV and hepatitis B virus co-infection leads to substantially increased morbidity and mortality compared with either infection alone. Immunisation with hepatitis B virus vaccine is the most effective way to prevent the infection in people with HIV; however, these patients have decreased vaccine responses and a short duration of protection compared with immunocompetent individuals. Control of HIV replication with highly active antiretroviral therapy and increased CD4 cell counts are associated with improved immune responses to hepatitis B vaccination. New vaccination strategies, such as increased vaccine dose, use of the intradermal route, and addition of adjuvants, could improve response rates in adults with HIV.
Collapse
|
4
|
Irungu E, Mugo N, Ngure K, Njuguna R, Celum C, Farquhar C, Dhanireddy S, Baeten JM. Immune response to hepatitis B virus vaccination among HIV-1 infected and uninfected adults in Kenya. J Infect Dis 2012; 207:402-10. [PMID: 23175769 DOI: 10.1093/infdis/jis695] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In studies from high-income countries, human immunodeficiency virus type 1 (HIV-1)-infected persons have diminished responses to hepatitis B virus (HBV) vaccination, compared with HIV-1-uninfected persons, but data from other settings are limited. METHODS We compared the immune response to HBV vaccination among HIV-1-infected and HIV-1-uninfected Kenyan adults and assessed the response of HIV-1-infected initial nonresponders to revaccination with a standard HBV vaccine series. RESULTS Of 603 participants, 310 (51.4%) were HIV-1-infected, for whom the median CD4(+) T-cell count was 557 cells/μL (interquartile range, 428-725 cells/μL); none were receiving antiretroviral therapy. Nonresponse to HBV vaccine was higher among HIV-1-infected participants, compared with HIV-1-uninfected participants (35.8% vs 14.3%; odds ratio, 3.33; P < .001). Of 102 HIV-1-infected initial nonresponders, 88 (86.3%) responded to revaccination, for an overall response, including to revaccination, of 94.9%. Among HIV-1-infected individuals, lower CD4(+) T-cell counts and male sex were independent predictors of nonresponse to initial vaccination, and lower body mass index, higher plasma HIV-1 RNA levels, and longer time to revaccination predicted nonresponse to revaccination. CONCLUSIONS Kenyan adults had similar HBV vaccination responses as persons from high-income countries. Timely revaccination of HIV-1-infected nonresponders increased response to the vaccine to 95%.
Collapse
Affiliation(s)
- Elizabeth Irungu
- Department of Epidemiology, University of Washington, Seattle, WA 98104, USA
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Hepatitis B vaccination in HIV-infected youth: a randomized trial of three regimens. J Acquir Immune Defic Syndr 2011; 56:325-32. [PMID: 21350366 DOI: 10.1097/qai.0b013e318203e9f2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND HIV-infected youth are at risk of hepatitis B infection and should be vaccinated. Previous reports suggest reduced response to standard hepatitis B vaccine regimens. METHODS HIV-infected youth, aged 12 to younger than 25 years, were randomly assigned to one of three treatment arms: Arm 1: Engerix B, 20 μg HBsAg; Arm 2: Engerix B (GlaxoSmithKline, Rixensart, Belgium), 40 μg; and Arm 3: Twinrix (GlaxoSmithKline, Rixensart, Belgium), 20 μg HBsAg combined with 720 ELU hepatitis A antigen. Vaccines were administered at Weeks 0, 4, and 24. RESULTS Characteristics of evaluable patients (n = 336) at entry were similar in the study arms. At enrollment, median CD4+ T-cell count was 460 cells/mm3 (interquartile range, 305-668); 13% were less than 200 cells/mm3. Among Engerix B, 20-μg recipients, 60.4% responded to vaccine (HBsAb 10 IU/mL or greater at Week 28). Improved vaccine response was seen in recipients of Engerix B, 40 μg (73.2% versus Arm 1, P = 0.04) and Twinrix (75.4% versus Arm 1, P = 0.02). In multivariate analysis, only baseline CD4+ T-cell count and study arm were independent predictors of vaccine response. CONCLUSIONS In HIV-infected youth, a three-dose vaccination regimen with Engerix B, 40 μg, or Twinrix and higher baseline CD4+ T-cell counts were independently associated with improved vaccine response.
Collapse
|
6
|
Kim HN, Harrington RD, Crane HM, Dhanireddy S, Dellit TH, Spach DH. Hepatitis B vaccination in HIV-infected adults: current evidence, recommendations and practical considerations. Int J STD AIDS 2009; 20:595-600. [PMID: 19710329 DOI: 10.1258/ijsa.2009.009126] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Immunization with hepatitis B (HBV) vaccine is recommended for all HIV-infected individuals without immunity to HBV. This patient population, however, has relatively poor HBV vaccine responses. Factors associated with this impaired HBV vaccine response in HIV-infected individuals may include older age, uncontrolled HIV replication, and low nadir CD4 cell count. Postvaccination testing for HBV surface antibody is recommended and vaccine non-responders should undergo repeat immunization with a full series. The benefit of double dosage, the appropriate strategy for HIV-infected patients with isolated HBV core antibody and the timing and number of vaccinations in persons with advanced immunosuppression on highly active antiretroviral therapy remain controversial areas.
Collapse
Affiliation(s)
- H N Kim
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA.
| | | | | | | | | | | |
Collapse
|