HBV Vaccination in HIV Patients 

By Marina Nunez, MD, PhD

HBV vaccination is known to be less successful in HIV-infected subjects. The factors predicting HBV vaccine failure were investigated in a military cohort including 873 HIV+ patients negative for HBV infection by clinical history and serology. The incidence of HBV infection was determined and compared between vaccinated (n= 430) and unvaccinated (n=443) individuals.

Race, sex, peak HIV load, nadir CD4 counts, and HCV infection were comparable between the vaccinated and unvaccinated groups. As expected, significantly less cases of HBV infection occurred among vaccinated patients (24) than among unvaccinated subjects (64) (8.4/1,000 versus 34/1,000 person-years; p<0.001) [OR for vaccination 0.25 (95% CI 0.15-0.39)].

Unvaccinated subjects were less likely to have ever received HAART (18% versus 63%, p<0.001). In multivariate analysis, adjusting for age and CD4 count, not receiving HAART at the time of vaccination [OR 8.19 (95% CI 1.04-62.5)] and coinfection with HCV [OR 7.75 (95% CI 2.44-24.4)] predicted clinical vaccine failure.

There may be some unidentified factors for vaccination selection that might have acted as confounding factors, but these data suggest that HAART use increases the protection provided by HBV vaccination while decreasing the incidence of new HBV infections.

02/21/06

Reference
M Landrum and others. The clinical efficacy of hepatitis B vaccine in HIV-infected individuals. 13th Conference on Retroviruses and Opportunistic Infections. February 5-8, 2006, Denver, CO. Abstract 840.