Brief Report: Response to Hepatitis A Virus Vaccine in HIV-Infected Patients Within a Retrospective, Multicentric Cohort: Facing Hepatitis A Outbreaks in the Clinical Practice

Abstract

Background: Various recent outbreaks of hepatitis A virus (HAV) have been described in men who have sex with men despite the availability of an effective vaccine. This study aimed to determine the current rates of seroconversion after receiving HAV vaccine (HAV-V) in HIV-infected patients under real-life conditions. Setting: Patients were selected from a Southern Spanish multicentric cohort of HIV-infected subjects. Methods: Retrospective analysis of all patients who received 2 doses (standard scheme) from April 2008 to May 2016 or from June 2016 to February 2018 facing an HAV outbreak with shortage of HAV-V, 1 single dose of HAV-V. Response to HAV-V was defined as positive anti-HAV IgG between 1 and 12 months after the last vaccination dose. Results: A total of 522 patients were included, mainly men who have sex with men (86.2%). In the standard-dose group, 303/343 [88.3%; 95% confidence interval (CI): 84.5 to 91.5] patients showed seroconversion as compared with 149/179 (83.2%; 95% CI: 76.9 to 88.4) of the single-dose group (P = 0.107). Undetectable baseline HIV-RNA (adjusted odds ratio: 4.86; 95% CI: 1.86 to 12.75; P = 0.001) and a CD4+ T-cell count ≥350/μL (adjusted odds ratio, 3.96; 95% CI: 1.26 to 12.49; P = 0.019) were independently associated with response to both regimens. A higher CD4/CD8+ ratio was also associated with response after a single dose. Conclusions: HIV-infected patients should be encouraged to undergo HAV-V with 2 standard doses 6 months apart; a single dose achieves a high rate of seroconversion in those patients with favorable response factors and may be enough to limit future outbreaks in case of HAV-V shortage until supply is reestablished.

Predictors associated with a better response to the Japanese aluminum‐free hepatitis A vaccine, Aimmugen®, for people living with HIV

“…In this study, we examined the efficacy of Aimmugen ® for MSM-LWHIV and found that the acquisition of anti-HA-IgG after the third dose was 98.6%, comparable to non-HIV-infected healthy adults. Unlike previous studies in other countries reporting a weaker HAV vaccine response in PLWHIV, [16][17][18][19][20][21][22] our results showed higher efficacy in MSM-LWHIV after the third dose, close to the 100% efficacy in non-HIV infected subjects. However, the acquisition of anti-HA-IgG after the second dose was 71.1%, which was relatively lower than 85% in non-HIV healthy adults.…”

“…In recent years, studies from other countries have reported the antibody acquisition rate of standard inoculation with VAQTA ® and HAVRIX ® in PLWHIV, [17][18][19][20][21][22] is mainly used, the acquisition rate of anti-HA-IgG in PLWHIV was around 90%, [17][18][19][20][21][22] which is lower than the 98.6% in this study. The difference in efficacy may be partially due to the vaccine itself.…”

“…In recent years, factors contributing to anti-HA-IgG acquisition after HAV vaccination in PLWHIV have been reported. [17][18][19][20][21][22]27 Higher CD4 count, undetectable HIV-RNA, and younger age were associated with higher efficacy of VAQTA ® and HAVRIX ® standard inoculation. These findings are similar to our results, wherein long-term viral suppression seems to contribute to antibody acquisition.…”

Humoral and cellular immunity to SARS-COV-2 after vaccination with mRNA vaccines in PLWH with discordant immune response. Influence of the vaccine administered

“…Among PLWH with low CD4 + T cell counts, there is a group that deserves special consideration, characterized by poor CD4 + T cell recovery despite sustained successful viral suppression, known as discordant immune responders (DIR). They show higher rates of morbidity and mortality associated with AIDS and non-AIDS events, in whom lower effectiveness of vaccines can be expected (26)(27)(28)(29), and whose response to these vaccines has not been extensively characterized (30). Therefore, it would be advisable to characterize the immune response and the correlates of vaccine efficacy in these subjects.…”

“…IL-4 and IL-21 are cytokines commonly secreted by T cells and Tfh cells after antigenic stimulation. Both have an essential role in the expansion, differentiation of B cells and production of memory B cells after exposure to an antigen or vaccination [26,27].…”