Immune response to the hepatitis B vaccine among HIV-infected adults in Uganda.

Abstract

BACKGROUND\nCo-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in sub-Saharan Africa (SSA) and can rapidly progress to cirrhosis and hepatocellular carcinoma. Recent data demonstrate ongoing HBV transmission among HIV-infected adults in SSA, suggesting that complications of HIV/HBV co-infection could be prevented with HBV vaccination. Because HBV vaccine efficacy is poorly understood among HIV-infected persons in SSA, we sought to characterize the humoral response to the HBV vaccine in HIV-seropositive Ugandan adults.\n\n\nMETHODS\nWe enrolled HIV-infected adults in Kampala, Uganda without serologic evidence of prior HBV infection. Three HBV vaccine doses were administered at 0, 1 and 6\xa0months. Anti-HBs levels were measured 4\xa0weeks after the third vaccine dose. Response to vaccination was defined as anti-HBs levels\xa0≥\xa010\xa0IU/L and high response as\xa0≥\xa0100\xa0IU/L. Regression analysis was used to determine predictors of response.\n\n\nRESULTS\nOf 251 HIV-positive adults screened, 132 (53%) had no prior HBV infection or immunity and were enrolled. Most participants were women [89 (67%)]; median (IQR) age was 32\xa0years (27-41), and 68 (52%) had received antiretroviral therapy (ART) for\xa0>\xa03\xa0months. Median (IQR) CD4 count was 426 (261-583), and 64 (94%) of the 68 receiving ART had undetectable plasma HIV RNA. Overall, 117 (92%) participants seroconverted to the vaccine (anti-HBs\xa0≥\xa010\xa0IU/L), with 109 (86%) participants having high-level response (anti-HBs\xa0≥\xa0100\xa0IU/L). In multivariate analysis, only baseline CD4\xa0>\xa0200 cells/mm3 was associated with response [OR\xa0=\xa06.97 (1.34-34.71), p\xa0=\xa00.02] and high-level response [OR\xa0=\xa04.25 (1.15-15.69)], p\xa0=\xa00.03].\n\n\nCONCLUSION\nHBV vaccination was effective in eliciting a protective humoral response, particularly among those with higher CD4 counts. Half of the screened patients did not have immunity to HBV infection, suggesting a large at-risk population for HBV infection among HIV-positive adults in Uganda. Our findings support including HBV vaccination as part of routine care among HIV-positive adults.