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Title:
Efficacy of vaccination against viral hepatitis B in HIV infected persons
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Subject:
HIV infection ; efficacy ; vaccination ; hepatitis B
Abstract:
The aim of the study was assessment of the efficacy of the standard vaccination against HBV among HIV infected patients and vaccination with additional doses in patients who did not develop the protective level of antibody after the initial vaccination. Analysis of the influence on the vaccination such factors like: stage of HIV infection, antiretroviral therapy, age and patient’s sex and co-infection with HCV has been done. The impact of the vaccination on the course of HIV has been assessed. Protective level of anti-HBs antibodies after the primary vaccination course was found in 92,9% persons of control group and only in 63% of HIV infected individuals. Anti-HBs above 100 IU/l was twice more common in control group (80,4%) than in HIV infected (46,3%) and differences were statistically significant (p < 0,001). Only 14,3% of patients with CD4 cell count below 200 cells/µl developed protective level of anti-HBs, none of them had anti-HBs above 100 IU/l, whereas patients with higher CD4 cells count responded better for vaccination (p = 0,015). Protective level of anti-HBs was a little bit more common among persons with viral load lower than 10 000 copies/ml (64,6%) in comparison with group of patients with higher viral load (50%). The CD4 cells count and viral load in the past (CD4min, HIV-RNAmax) did not have impact on the vaccination efficacy, but the worst response was obser ; ved in patients with CD4min lower than 200 cells/µl and HIV-RNAmax higher than 50 000 copies/ml. After additional vaccine doses among investigated patients, who did not respond for the primary vaccination course, number of immunized person, also with anti-HBs level above 100 IU/l had been increasing. After the first additional vaccine dose percentage of person with anti-HBs above 10 U/l was 79,7%, after the second 87,1% and 90,7% after the third dose. Anti-HBs level above 100 IU/l had subsequently 57,4%, 66,7% and 79,6% patients. In conclusions: 1) efficacy of standard vaccination against HBV among HIV infected patients is lower than in healthy individuals, 2) extension of vaccine doses to six allow to improve immunization efficacy to the level observed in non HIV infected population, 3) stage of HIV infection has significant impact on efficacy of vaccination against HBV, whereas such factors as patients age, sex and HCV co-infection don’t have impact on immunological response for vaccine, 4) there is no correlation between vaccination against HBV and deterioration of HIV infection.