Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
J Acquir Immune Defic Syndr. 2011 Apr;56(4):325-32. doi: 10.1097/QAI.0b013e318203e9f2.
HIV-infected youth are at risk of hepatitis B infection and should be vaccinated. Previous reports suggest reduced response to standard hepatitis B vaccine regimens.
HIV-infected youth, aged 12 to younger than 25 years, were randomly assigned to one of three treatment arms: Arm 1: Engerix B, 20 μg HBsAg; Arm 2: Engerix B (GlaxoSmithKline, Rixensart, Belgium), 40 μg; and Arm 3: Twinrix (GlaxoSmithKline, Rixensart, Belgium), 20 μg HBsAg combined with 720 ELU hepatitis A antigen. Vaccines were administered at Weeks 0, 4, and 24.
Characteristics of evaluable patients (n = 336) at entry were similar in the study arms. At enrollment, median CD4+ T-cell count was 460 cells/mm3 (interquartile range, 305-668); 13% were less than 200 cells/mm3. Among Engerix B, 20-μg recipients, 60.4% responded to vaccine (HBsAb 10 IU/mL or greater at Week 28). Improved vaccine response was seen in recipients of Engerix B, 40 μg (73.2% versus Arm 1, P = 0.04) and Twinrix (75.4% versus Arm 1, P = 0.02). In multivariate analysis, only baseline CD4+ T-cell count and study arm were independent predictors of vaccine response.
In HIV-infected youth, a three-dose vaccination regimen with Engerix B, 40 μg, or Twinrix and higher baseline CD4+ T-cell counts were independently associated with improved vaccine response.
感染 HIV 的青少年有感染乙型肝炎的风险，应接种疫苗。既往报告提示其对标准乙型肝炎疫苗方案的应答减弱。
12 岁以下至 25 岁以下的 HIV 感染青少年被随机分配至 3 个治疗组之一：A 组：安在时，20μg 乙肝表面抗原；B 组：安在时（葛兰素史克，比利时里克斯纳），40μg；C 组：双福立适（葛兰素史克，比利时里克斯纳），20μg 乙肝表面抗原联合 720ELU 型甲型肝炎抗原。疫苗在第 0、4 和 24 周时给药。
入组时可评估患者（n=336）的特征在研究组中相似。入组时，中位 CD4+T 细胞计数为 460 个细胞/mm3（四分位距，305-668）；13%的患者低于 200 个细胞/mm3。安在时 20μg 组中，60.4%的患者对疫苗有应答（接种第 28 周时 HBsAb 大于等于 10IU/mL）。安在时 40μg 组（73.2%比 A 组，P=0.04）和双福立适组（75.4%比 A 组，P=0.02）的疫苗应答改善。多变量分析显示，仅基线 CD4+T 细胞计数和研究组是疫苗应答的独立预测因素。
在 HIV 感染青少年中，安在时 40μg 或双福立适与较高的基线 CD4+T 细胞计数联合三剂接种方案与改善的疫苗应答相关。
