Ahuja Tejinder S, Kumar Sajal, Mansoury Hadi, Rodriguez Hector, Kuo Yong-Fang
Division of Nephrology, Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA.
Kidney Int. 2005 Mar;67(3):1136-41. doi: 10.1111/j.1523-1755.2005.00180.x.
The Centers for Disease Control and Prevention (CDC) recommends hepatitis B virus (HBV) immunization for all hemodialysis (HD) patients because they are at high risk of infection. Several studies have shown that the development of protective antibody titers after HBV vaccination is much lower in HD patients. We hypothesized that human immunodeficiency virus (HIV) infection in patients with end-stage renal disease (ESRD) would further impair the immune response to hepatitis B vaccination.
We performed a retrospective cohort study of patients undergoing long-term hemodialysis from 1990 to 2002 at the United States-based dialysis facilities of Gambro Corporation, North America. The response rate defined as an increase in anti-HBs levels >/=10 mIU/L after a month of the third dose of HBV vaccination was determined in HIV-infected and a randomly selected group of ESRD patients. The demographic information, laboratory data, and hepatitis B surface antibody (anti-HBs) titers were recorded from the Gambro Corporation database on these patients.
Of the 347 adult HIV ESRD patients, 116 received three doses of recombinant hepatitis B vaccination. Seventy percent were male, and the majority (86%) were black. Of the 116 patients who received three doses of HBV vaccination, 62 (53.4%) developed protective antibody titers. This was comparable to the response rate of 50.4% in the randomly selected 220 non-HIV hemodialysis patients. Among HIV ESRD patients, the mean hemoglobin (Hgb) was higher in patients who developed protective antibody titers (Hgb 11.61 +/- 2 vs. 10.55 +/- 1.86, P value <0.01). On multivariate logistic regression analysis, higher Hgb was associated with protective antibody titers (odds ratio: 1.34, 95% CI 0.99-1.72). Seventy percent of the HIV-infected responders maintained protective antibody titers 6 months after vaccination.
Hepatitis B vaccination should be offered to all HIV-infected ESRD patients because over half of the patients with HIV and ESRD can develop protective antibodies.
美国疾病控制与预防中心（CDC）建议对所有血液透析（HD）患者进行乙型肝炎病毒（HBV）免疫接种，因为他们感染风险很高。多项研究表明，HD患者接种HBV疫苗后保护性抗体滴度的产生率要低得多。我们推测，终末期肾病（ESRD）患者中的人类免疫缺陷病毒（HIV）感染会进一步损害对乙型肝炎疫苗的免疫反应。
我们对1990年至2002年在美国甘布罗公司北美透析机构接受长期血液透析的患者进行了一项回顾性队列研究。在HIV感染患者和一组随机选择的ESRD患者中，确定了接种第三剂HBV疫苗一个月后抗-HBs水平升高≥10 mIU/L的反应率。从甘布罗公司数据库记录了这些患者的人口统计学信息、实验室数据和乙型肝炎表面抗体（抗-HBs）滴度。
在347例成年HIV ESRD患者中，116例接受了三剂重组乙型肝炎疫苗接种。70%为男性，大多数（86%）为黑人。在116例接受三剂HBV疫苗接种的患者中，62例（53.4%）产生了保护性抗体滴度。这与随机选择的220例非HIV血液透析患者50.4%的反应率相当。在HIV ESRD患者中，产生保护性抗体滴度的患者平均血红蛋白（Hgb）较高（Hgb 11.61±2 vs. 10.55±1.86，P值<0.01）。多因素逻辑回归分析显示，较高的Hgb与保护性抗体滴度相关（比值比：1.34，95%CI 0.99-1.72）。70%的HIV感染反应者在接种疫苗6个月后维持保护性抗体滴度。
应向所有HIV感染的ESRD患者提供乙型肝炎疫苗接种，因为超过一半的HIV和ESRD患者可产生保护性抗体。
