Low HIV viral load linked to hepatitis B vaccination response

Successful hepatitis B vaccination in HIV-infected patients appears to be dependent on a low plasma HIV RNA level, researchers report in the October 1st issue of Clinical Infectious Diseases.

Our data reinforce that HIV-infected adults respond poorly to hepatitis B vaccination and that responses are improved with controlled viremia, lead investigator Dr. Edgar Turner Overton told Reuters Health. With the current strategies of waiting to initiate antiretroviral therapy…we are left with a question of when to vaccinate against hepatitis B, at the point of entry to care with ongoing viremia or several years later when viremia is controlled. Dr. Overton of Washington University School of Medicine, St. Louis, and colleagues retrospectively reviewed the records of 194 HIV-infected patients who underwent hepatitis B vaccination.

Only 34 (17.5%) developed a protective antibody response. The sole factor associated with a successful response was a plasma HIV RNA level lower than 400 copies per mL at the time of vaccination (p = 0.003). The researchers note that the responders were protected against hepatitis B and none subsequently developed the infection. However, 10% of nonresponders became infected.

Current vaccine strategies are not ideal, continued Dr. Overton. Fortunately, several new hepatitis B vaccines are being evaluated for high risk persons with decreased response rates. We can hope that these novel approaches will yield better rates of protection.