Immunogenicity and immunologic memory after hepatitis B virus booster vaccination in HIV-infected children receiving highly active antiretroviral therapy
Mark J Abzug, Meredith Warshaw, Howard M Rosenblatt, Myron J Levin, Sharon A Nachman, Stephen I Pelton, William Borkowsky, Terence Fenton, International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1024 and P1061s Protocol Teams, Shirley Jankelevich, Jennifer Read, Victoria Hadhazy, Alison Robbins, Jane C Lindsey, Janice Hodge, Dorothy Smith, Paul Tran, Grace Aldrovandi, Rachel Barrett, William Kabat, Velma Keeley, Paul Willems, Carol Gore, Mark J Abzug, Meredith Warshaw, Howard M Rosenblatt, Myron J Levin, Sharon A Nachman, Stephen I Pelton, William Borkowsky, Terence Fenton, International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1024 and P1061s Protocol Teams, Shirley Jankelevich, Jennifer Read, Victoria Hadhazy, Alison Robbins, Jane C Lindsey, Janice Hodge, Dorothy Smith, Paul Tran, Grace Aldrovandi, Rachel Barrett, William Kabat, Velma Keeley, Paul Willems, Carol Gore
Abstract
Background: Hepatitis B virus (HBV) is an important cause of comorbidity in human immunodeficiency virus (HIV)-infected individuals. The immunogenicity of HBV vaccination in children receiving highly active antiretroviral therapy (HAART) was investigated.
Methods: HIV-infected children receiving HAART who had low to moderate HIV loads and who had previously received 3 doses of HBV vaccine were given an HBV vaccine booster. Concentrations of antibody to hepatitis B surface antigen (anti-HBs) were determined before vaccination and at weeks 8, 48, and 96. A subset of subjects was administered a subsequent dose, and anti-HBs was measured before and 1 and 4 weeks later.
Results: At entry, 24% of 204 subjects were seropositive. Vaccine response occurred in 46% on the basis of seropositivity 8 weeks after vaccination and in 37% on the basis of a 4-fold rise in antibody concentration. Of 69 subjects given another vaccination 4-5 years later, immunologic memory was exhibited by 45% on the basis of seropositivity 1 week after vaccination and by 29% on the basis of a 4-fold rise in antibody concentration at 1 week. Predictors of response and memory included higher nadir and current CD4 cell percentage, higher CD19 cell percentage, and undetectable HIV load.
Conclusions: HIV-infected children frequently lack protective levels of anti-HBs after previous HBV vaccination, and a significant proportion of them do not respond to booster vaccination or demonstrate memory despite receiving HAART, leaving this population insufficiently protected from infection with HBV.
Trial registration: ClinicalTrials.gov NCT00013871.
Conflict of interest statement
Potential conflicts of interest: M.J.L. has received research funding from GlaxoSmithKline Pharmaceuticals (herpes simplex virus vaccine and human papillomavirus vaccine); research funding, intellectual property rights, and consultant fees from Merck & Co; and consultant fees from MedImmune and Astellas Pharmaceuticals. S.A.N. has been a consultant for Medimmune, Merck & Co, and Sanofi Pasteur. S.I.P. has served on the vaccine advisory boards of GlaxoSmithKline Pharmaceuticals (pneumococcal and meningococcal vaccine), Wyeth Pharmaceuticals (pneumococcal vaccine), and Sanofi Pasteur (meningococcal, tetanus, diphtheria, pertussis, poliovirus, and Haemophilus influenzae B vaccine) and has received research funding from Wyeth Pharmaceuticals and Sanofi Pasteur. W.B. has received research funding from GlaxoSmithKline Pharmaceuticals (fosamprenavir). All other authors report no potential conflicts.
Figures
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Proportion of P1024 subjects with…
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Proportion of P1024 subjects with protective concentrations (≥10 mIU/mL) of antibody to hepatitis…
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Median concentrations of antibody to…
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Median concentrations of antibody to hepatitis B surface antigen (anti-HBs) in P1024. Subjects…
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- Clinical Trial
- Research Support, N.I.H., Extramural
- Adolescent
- Anti-HIV Agents / administration & dosage
- Anti-HIV Agents / therapeutic use
- Antiretroviral Therapy, Highly Active*
- Child
- Child, Preschool
- Female
- HIV Infections / drug therapy*
- HIV Infections / immunology*
- Hepatitis B Antibodies / blood
- Hepatitis B Vaccines / administration & dosage*
- Hepatitis B Vaccines / immunology*
- Humans
- Immunization, Secondary
- Immunologic Memory / immunology*
- Male
- RNA, Viral / blood
- Time Factors
- Anti-HIV Agents
- Hepatitis B Antibodies
- Hepatitis B Vaccines
- RNA, Viral
- ClinicalTrials.gov/NCT00013871
- Full Text Sources
- Medical
- Research Materials
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Source: PubMed