HIV Treatment Bulletin - Vol. 5, No. 7, August/September 2004

Simon Collins, HIV i-Base

Rimland and colleagues from the VA Medical Center, Atlanta, Georgia analysed responses to hepatitis A vaccine in 214 patients who were vaccinated between 1996 and 2003 (standard dose and schedule).

Overall, 130 of 214 vaccinated individuals developed HAV antibody (61%). Response rate by CD4 count at time of vaccination were 83%, 62%, 39%, 27% and 8% in patients with CD4 >500, 201-500, 101-200, 51-100 and <50 cells/mm³ respectively (p<0.0001).

In a multivariate analysis, only CD4 at time of vaccination (and not CD4 nadir) was associated with absence of response (p<0.0001). HCV infection was not associated with response.

The study concluded that determination of hepatitis A antibody after vaccination should be considered in all HIV patients receiving HAV vaccine. CD4 at time of vaccination is the critical determinant of response to HAV vaccine. Also, that the absence of a multivariate association with nadir CD4 suggested that patients may respond to HAV vaccine after immunologic reconstitution in response to HAART.

Response to HA vaccine by CD4 count at time of vaccination:

Reference: Rimland D, Guest JL. Response to hepatitis A vaccine in HIV patients in the HAART era. Int Conf AIDS. 2004 Jul 11-16;15:Abstract No. MoPeB3299 (this report based on revised abstract in poster).

Comment

These two sets of studies underpin the importance of early consideration of Hepatitis A and B vaccination in HIV-infected patients and in particular patients co-infected with HCV.

Overall, CD4 counts at time of vaccination, rather than nadir CD4 counts, seem to be an important factor in determining response to hepatitis A (as judged by appearance of antibodies in HAV). Therefore, early use of vaccination is optimum, but as demonstrated by Rimland et al, there is a 60% or more response for HAV vaccine with CD4 counts over 200 cells/mm³.

The use of double-dose vaccination in hepatitis B is a strategy already adapted by renal physicians for patients on dialysis, and Fonseca and colleagues provide evidence that this may be applicable in HIV-infected patients as well.

040810
IB040507-18

©2004. I-BASE HIV Treatment Bulletin. Permission to reproduce courtesy of HIV i-Base, Third Floor East, Thrale House, 44-46 Southwark Street, London SE1 1UN - T: +44 (0) 20 7407 8488 F: +44 (0) 20 7407 8489

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, John M. Lloyd Foundation, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2004. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2004. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.