Comparative effectiveness of two doses versus three doses of hepatitis A vaccine in human immunodeficiency virus-infected and -uninfected men who have sex with men

Abstract

The purpose of this prospective cohort study was to compare the serologic response between human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) receiving two and three doses of hepatitis A virus (HAV) vaccine and HIV-uninfected MSM receiving two doses of HAV vaccine. Between June 2009 and December 2010, 582 MSM aged 18 to 40 years who were seronegative for HAV were enrolled in the study. HIV-infected MSM received either two doses of HAV vaccine (1,440 enzyme-linked immunosorbent assay units) (n 5 140) with the second dose given at week 24 or three doses (n 5 225) with the second and third dose given at weeks 4 and 24, respectively, while HIVuninfected MSM (n 5 217) received two doses. The primary endpoint was seroconversion at week 48. The geometric mean concentration (GMC) of anti-HAV antibody was determined at weeks 48 and 72. At week 48, the seroconversion rate was 75.7%, 77.8%, and 88.5% in intention-to-treat analysis for two-dose HIV-infected, three-dose HIV-infected, and two-dose HIV-uninfected MSM, respectively. The GMC of anti-HAV antibody at week 48 for three-dose HIV-infected MSM (2.29 6 0.73 log 10 mIU/mL) was significantly higher than that for two-dose HIV-infected MSM (1.94 6 0.66; P < 0.01), but was lower than HIV-uninfected MSM (2.49 6 0.42; P < 0.01). Multivariate analysis revealed higher CD4 counts (adjusted odds ratio [AOR] for per 50 cells/lL increase, 1.13; 95% confidence interval [CI], 1.05-1.21) and undetectable plasma HIV RNA load (AOR, 1.90; 95% CI, 1.10-3.28) before HAV vaccination were predictive of seroconversion in HIV-infected patients. Conclusion: Serologic response rate to three and two doses of HAV vaccine was similar in HIV-infected MSM, which was lower than that in HIV-uninfected MSM receiving two doses. HAV vaccination in HIV-infected patients with a higher CD4 count and suppression of HIV replication increased the seroconversion rate. (HEPATOLOGY

Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review

“…Of the two types of HAV vaccines that are currently available internationally, the live attenuated vaccine (based on H2 or LA-1 HAV strains and manufactured as well as mainly used in China or India) and the inactivated HAV vaccine (based on clinical trials since 1991 and licensed in the United States since 1995), only the latter is recommended for HIV-positive individuals. There are 3 formulations of inactivated HAV vaccines that have been assessed in HIV-positive individuals with varying degrees of immunodeficiency as shown in Table 7[115-129]. Although different specific anti-HAV IgG titers have been used to define seroconversion (10, 18, 20, or 33 mIU/mL), the majority of these studies have adopted 20 mIU/ml as the surrogate titer for seroprotection.…”

“…In a meta-analysis including 8 studies, combining a total of 458 HIV-positive patients, the overall rate of serological response to HAV vaccination was 64%[130]. In addition, the geometric mean titers (GMTs) of specific antibodies were also lower among HIV-positive individuals compared to the healthy population[115,123,127]. …”

“…Overall, factors that correlated best with the poor response to HAV vaccination among HIV-positive individuals were surrogates of immune status such as low CD4 cell counts and high plasma HIV RNA loads at the time of vaccination as shown in Table 7[115-129]. Other factors identified with low rates of seroconversion were HCV coinfection and tobacco smoking[116,120].…”

“…Other attempts were by increasing the number of doses of vaccine administered[115,120,121]. Two doses over 1 dose of HIV vaccine increased seroconversion rates in HIV-positive individuals[121,123,124].…”

Immunization of HIV-infected adult patients — French recommendations

“…Studies that have compared vaccination response on the basis of the number of doses received (2 versus 3) showed that the proportion of responders and titer of antibodies were higher after the third dose. 53,55 The duration of protection is shorter than in HIV-uninfected subjects. After 4 years of follow-up, 85% of vaccinated patients who were responders have maintained a level of protective antibodies.…”