Comparative Efficacy of a High-Dose vs Standard-Dose Hepatitis B Revaccination Schedule Among Patients With HIV

Vargas, José Ignacio; Jensen, Daniela; Martínez, Felipe; Sarmiento, Valeska; Peirano, Felipe; Acuña, Pedro; Provoste, Felipe; Bustos, Valentina; Cornejo, Francisca; Fuster, Antonieta; Acuña, Martin; Fuster, Felipe; Soto, Sabrina; Estay, Denisse; Jensen, Werner; Ahumada, Rodrigo Bravo; Arab, Juan Pablo; Soza, Alejandro; Fuster, Francisco

doi:10.1001/jamanetworkopen.2021.20929

Cited by 18 publications

(22 citation statements)

References 28 publications

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“…For patients undergoing dialysis therapy, alternative strategies include the use of adjuvants, additional vaccination cycles, different vaccine formulations, greater number and concentration of doses, greater frequency of doses, dual vaccination, alternative administration routes, and/or use of booster vaccines[ 67 , 72 , 84 - 86 ]. On the other hand, for HIV-infected individuals with negative or < 10 mIU/mL anti-HBs levels after a primary vaccine series, a second HBV vaccine series using larger or additional doses is recommended[ 71 , 87 ]. Furthermore, revaccination should be attempted after HIV viral load suppression and CD4 cell count improvement[ 83 ].…”

Section: Management Of Special Populationsmentioning

confidence: 99%

Insights into induction of the immune response by the hepatitis B vaccine

Lello¹,

Martínez²,

Flichman³

2022

WJG

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After more than four decades of hepatitis B virus (HBV) vaccine implementation, its safety and efficacy in preventing HBV infection have been proven and several milestones have been achieved. Most countries have included HBV immunization schedules in their health policies and progress has been made regarding universalization of the first HBV vaccine dose at birth. All of these actions have significantly contributed to reducing both the incidence of HBV infection and its related complications. However, there are still many drawbacks to overcome. The main concerns are the deficient coverage rate of the dose at birth and the large adult population that has not been reached timely by universal immunization. Additionally, the current most widely used second-generation vaccines do not induce protective immunity in 5% to 10% of the population, particularly in people over 40-years-old, obese (body mass index > 25 kg/m 2 ), heavy smokers, and patients undergoing dialysis or infection with human immunodeficiency virus. Recently developed and approved novel vaccine formulations using more potent adjuvants or multiple antigens have shown better performance, particularly in difficult settings. These advances re-launch the expectations of achieving the World Health Organization’s objective of completing hepatitis control by 2030.

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Section: Management Of Special Populationsmentioning

confidence: 99%

Insights into induction of the immune response by the hepatitis B vaccine

Lello¹,

Martínez²,

Flichman³

2022

WJG

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“…Age is an important factor for reduced immunogenicity and vaccine-induced protection due to immunosenescence ( 30 ). Higher antigen doses of influenza or hepatitis B vaccines enable to increase vaccine responses in older adults or patients at risk for vaccine non response ( 31 , 32 ). Therefore, it can be speculated that the higher dose of the mRNA-1273 may overcome an age-related decrease in immunogenicity.…”

Section: Discussionmentioning

confidence: 99%

Type of mRNA COVID-19 vaccine and immunomodulatory treatment influence humoral immunogenicity in patients with inflammatory rheumatic diseases

et al. 2022

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Patients with inflammatory rheumatic diseases (IRD) are at increased risk for worse COVID-19 outcomes. Identifying whether mRNA vaccines differ in immunogenicity and examining the effects of immunomodulatory treatments may support COVID-19 vaccination strategies. We aimed to conduct a long-term, model-based comparison of the humoral immunogenicity following BNT162b2 and mRNA-1273 vaccination in a cohort of IRD patients. Patients from the Swiss IRD cohort (SCQM), who assented to mRNA COVID-19 vaccination were recruited between 3/2021-9/2021. Blood samples at baseline, 4, 12, and 24 weeks post second vaccine dose were tested for anti-SARS-CoV-2 spike IgG (anti-S1). We examined differences in antibody levels depending on the vaccine and treatment at baseline while adjusting for age, disease, and past SARS-CoV-2 infection. 565 IRD patients provided eligible samples. Among monotherapies, rituximab, abatacept, JAKi, and TNFi had the highest odds of reduced anti-S1 responses compared to no medication. Patients on specific combination therapies showed significantly lower antibody responses than those on monotherapy. Irrespective of the disease, treatment, and past SARS-CoV-2 infection, the odds of higher antibody levels at 4, 12, and 24 weeks post second vaccine dose were, respectively, 3.4, 3.8, and 3.8 times higher with mRNA-1273 versus BNT162b2 (p < 0.0001). With every year of age, the odds ratio of higher peak humoral immunogenicity following mRNA-1273 versus BNT162b2 increased by 5% (p < 0.001), indicating a particular benefit for elderly patients. Our results suggest that in IRD patients, two-dose vaccination with mRNA-1273 versus BNT162b2 results in higher anti-S1 levels, even more so in elderly patients.

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“…The number of patients who received a single dose and had anti-HBs > 100 was 46/91 (50.5%), which is at considerably low level compared to the healthy population. In a prospective randomized study, it was shown that the serological response rate of those who received the high dose was 72%, while the rate of those who received the standard dose was 50% (17).…”

Section: Discussionmentioning

confidence: 99%

Hepatitis B immunization data of patients living with HIV/AIDS: a multi-centre study

Öztürk¹,

Özel²,

Ergen³

et al. 2022

Cent Eur J Public Health

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Objectives: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are the two leading viruses that cause the greatest number of virus-related morbidities in the world. HIV/HBV coinfection is correlated with high morbidity and mortality. For this particular reason hepatitis B vaccination is crucial for people living with HIV.Methods: Patients who are being followed-up for HIV/AIDS and who have received a hepatitis B vaccine in 4 HIV clinics over a 5-year time period have been studied. Our multi-centered, retrospective, cross-sectional and observational study investigates factors that affect hepatitis B vaccination immune response of individuals living with HIV. The patients have been studied for the parameters such as age, sex, CD4 count at the time of diagnosis or vaccination, HIV-RNA levels, comorbidities, vaccine dosage, success of immunization after vaccination, and the demographics of the patients who have and have not developed immunity.Results: Of 645 patients that are being followed-up in our clinics, 158 received hepatitis B vaccine; 39 of these 158 patients have been excluded from the study because they did not fulfil the inclusion criteria. Finally, 119 patients were evaluated in the study, 17 of the patients (14.3%) were females and 102 (85.7%) were males. The median age was 41.11 ± 10.09 (min-max: 18-75). Twenty-three of the patients (19.3%) were at the stage of AIDS during diagnosis while 80.7% were at the stage of HIV infection. Ninety-one of the patients (76.5%) have been administered a single dose hepatitis B vaccine on the standard 0, 1st, 6th month vaccination schedule, whereas 23.5% were administered a double dose on the same vaccination schedule. When further evaluated to find whether the patient was able to develop sufficient immunity (anti-HBs ≥ 10), it was found that the immune response was statistically significantly higher in the patients whose CD4 count was greater than 200 at the time of the first diagnosis and vaccination (p = 0.05 and p = 0.001, respectively). The patients have also been evaluated according to the number of doses they received (1 vs. 2). The immune response of the patients who received two doses was statistically significantly higher (p = 0.041). Conclusion:We can conclude that in the patients with CD4 count less than 200 at the time of their diagnosis and vaccination a high dose recombinant hepatitis B vaccine should definitely be administered as the normal dose and higher dose have similar side effect profiles and the higher dose provides greater immunity.

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Comparative Efficacy of a High-Dose vs Standard-Dose Hepatitis B Revaccination Schedule Among Patients With HIV

Cited by 18 publications

References 28 publications

Insights into induction of the immune response by the hepatitis B vaccine

Insights into induction of the immune response by the hepatitis B vaccine

Type of mRNA COVID-19 vaccine and immunomodulatory treatment influence humoral immunogenicity in patients with inflammatory rheumatic diseases

Hepatitis B immunization data of patients living with HIV/AIDS: a multi-centre study

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