Changes in hepatitis B serologic titers in HIV+ and HIV– children with haemophilia

Abstract

This longitudinal study examines differences in hepatitis B immune titres in children and adolescents with haemophilia to determine if they are dependent on how immunity was acquired (vaccination or natural infection), and whether they are related to the child's HIV status and/or are influenced by HIV disease progression. Serologic titres (HBcAb, HBsAb) and HBsAg were measured prospectively at baseline, and at years 1, 2 and 3 of follow-up in 126 HIV- and 207 HIV+ children and adolescents with haemophilia. Analyses were performed to assess the impact of HIV status on the measured titres, and for HIV+ subjects to examine the association with CD4+ lymphocyte counts and p24 antigen status. The results show that HIV+ children were more likely than HIV- children to lose vaccine-induced immunity as indicated by the loss of HBsAb. There was an increased risk of losing HBsAb with higher CD4+ counts and younger age. Re-immunization was not successful in seven of eight HIV+ children. Two subjects (one HIV+, one HIV-) entered the study HBsAg- but became HBsAg+ over the course of follow-up. Seven HIV+ subjects lost natural immunity as indicated by the loss of HBcAb. The loss of either HBsAb or HBcAb in HIV--subjects was negligible to absent. In conclusion, because of the loss of immunity in HIV+ children the viral safety of factor replacement concentrates for these children is an important consideration. HIV- children rarely lose immunity, therefore frequent measures of HBsAb are not necessary.

Immunity to hepatitis B vaccine in Tanzanian under-5 children

“…Compared with healthy children, HIV-infected children have a lower seroconversion rate to hepatitis B immunisation, a more rapid antibody decline and tend to lose vaccine-induced immunity. 21 It is also known that HIV-infected children tend to have immune recovery when using HAART.…”

HIV–HBV vaccine escape mutant infection with loss of HBV surface antibody and persistent HBV viremia on tenofovir/emtricitabine without antiviral resistance

“…However, it is known that HIV-positive patients are more likely to lose vaccination associated or naturally occurring HBsAb in comparison to HIV-negative patients. 11,12 One study in HIV-positive children noted that 6 of 90 HBV vaccinated children lost HBsAb after 1 year and demonstrated an increased likelihood of HBsAb loss with increasing CD4 cell count. 11 Our patient also had a rising CD4 count, concomitant with HBsAb loss.…”

“…11,12 One study in HIV-positive children noted that 6 of 90 HBV vaccinated children lost HBsAb after 1 year and demonstrated an increased likelihood of HBsAb loss with increasing CD4 cell count. 11 Our patient also had a rising CD4 count, concomitant with HBsAb loss. Unfortunately, similar studies in adults have not been published.…”

Blood Safety Monitoring Among Persons With Bleeding Disorders—United States, May 1998–June 2002

“…The implementation of such control programs in Northeastern states in the early 1990s might have contributed to sub-sequent decreases in human SE isolation rates in New England and Mid-Atlantic regions. 7 One important control measure is microbiologic testing of hen houses for the presence of SE. If SE is found on a farm during routine environmental testing, eggs may be diverted to pasteurization.…”