Long-term durability of responses to 2 or 3 doses of hepatitis A vaccination in HIV-positive adults on antiretroviral therapy

Abstract

Three doses versus 2 doses of HAV vaccine improve the durability of immune responses in terms of higher concentrations of specific IgG, which take longer to decay to subthreshold levels.

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

“…In HIV-positive individuals, a slight decrease was observed over time; 88.6%-100% of responders were still seroprotected after 1 year[115,120], 86.8%-90% after 3 years[135,136], 85%-85.4% after 4 years[136,137], and 75.5%-88.4% after 5 years[135,136,138]. Percentages of seroprotection at the end of 5 years of follow-up were 78.9% vs 76.4% by ITT analysis ( p = 0.61) (Table 8)[135-138].…”

“…Percentages of seroprotection at the end of 5 years of follow-up were 78.9% vs 76.4% by ITT analysis ( p = 0.61) (Table 8)[135-138]. GMTs were significantly higher throughout each consecutive year with the 3-dose schedule as compared to the standard 2-dose schedule[136]. Factors associated with persistent seroprotection include virologic suppression at vaccination and maintained lower levels of HIV viremia as denoted by time-updated plasma HIV RNA load[135,137], 3-dose compared to 2-dose schedule (adjusted odds ratio 3.36; 95%CI: 1.14-9.93), acute syphilis and absence of acute hepatitis C[136,138].…”

Early Seroreversion After 2 Doses of Hepatitis A Vaccination in Human Immunodeficiency Virus–Positive Patients: Incidence and Associated Factors

“…The retrospective design of our study of a shorter observation duration and the natural booster effect that might occur during an ongoing HAV outbreak may have contributed to the discrepancies observed. Another potential explanation could be that the population in our study was mostly virally suppressed and had higher baseline CD4 lymphocyte counts compared to those included in the previous studies . Of note, the sample size of the current study was 5 times as large as the two previously mentioned studies combined.…”

“…Although seroreversion cannot be translated directly into loss of protection, as shown in the anamnestic response after hepatitis B vaccination, AHA in HIV‐positive individuals who had had positive anti‐HAV antibodies has been reported, indicating that loss of seroprotective antibodies may lead to susceptibility to hepatitis A infection in the HIV‐positive population. Several studies reported a substantial rate of loss of HAV antibodies after vaccine‐induced seroconversion . Launay et al and Cheng et al, in their previous investigations, found that, at 18 months after vaccination, seroreversion rates were 6% and 13%, respectively .…”

“…In the general population, given its excellent immunogenicity and durability, booster doses after primary HAV vaccination are not recommended in most national and international guidelines; however, for HIV‐positive patients, most guidelines provide limited or no guidance on whether booster doses are needed, probably because there is a paucity of clinical evidence. Studies with small sample sizes have shown that 5%‐20% of HIV‐positive patients who had achieved seroresponses to HAV vaccination lost protective antibodies (seroreversion) within 18 months and 10%‐25% within 5 years . Based on these observations, booster HAV vaccination every 10 years for HIV‐positive patients with continuous risks of exposure is recommended by the British HIV Association…”