Mor Z, Lurie Y, Katchman E
Levinsky STI Clinic, Ministry of Health, Tel Aviv, Israel.
Int J STD AIDS. 2012 Jul;23(7):529-30. doi: 10.1258/ijsa.2010.010269.
Hepatitis A virus (HAV) vaccination is recommended for men who have sex with men (MSM) and other susceptible populations, who are at increased risk for HAV infection, such as HIV-positive persons. Vaccines failures are uncommon, and in HIV-positive individuals whose CD4 count is ≥ 500 cells/mm(2), seroconversion is achieved in 73-94% of vaccinees following the second dose. Data were retrieved from the patient's file at the sexually transmitted disease clinic and the AIDS clinic describing this rare case of vaccine failure. A 35-year-old, HIV-positive MSM was vaccinated against HAV on 2007, while his CD4 count was 551 cells/mm(2). Two years later, he was hospitalized due to acute HAV. The patient's serum drawn two months prior to the onset of acute HAV was retrospectively tested and showed no response to the vaccine. The source of the HAV infection was not identified. The patient's partner who was HIV-negative and had been vaccinated simultaneously with the same batch developed protective antibodies. In conclusion, HIV-positive patients and their providers should be informed about HAV vaccine failure, and post-immunization serologies to hepatitis should be considered to evaluate immunization response. Alternative approaches to develop immunity are needed for non-responders.
甲型肝炎病毒（HAV）疫苗推荐用于男男性行为者（MSM）及其他易感人群，这些人群感染HAV的风险增加，如HIV阳性者。疫苗接种失败情况并不常见，在CD4计数≥500个细胞/mm³的HIV阳性个体中，73% - 94%的接种者在接种第二剂疫苗后实现血清转化。数据取自性传播疾病诊所和艾滋病诊所的患者档案，描述了这例罕见的疫苗接种失败病例。一名35岁的HIV阳性MSM于2007年接种HAV疫苗，当时其CD4计数为551个细胞/mm³。两年后，他因急性甲型肝炎住院。对急性甲型肝炎发病前两个月采集的患者血清进行回顾性检测，结果显示对疫苗无反应。未确定HAV感染源。该患者的HIV阴性伴侣与他同时接种同一批次疫苗后产生了保护性抗体。总之，应告知HIV阳性患者及其医护人员有关HAV疫苗接种失败的情况，并应考虑进行接种后肝炎血清学检测以评估免疫反应。对于无反应者，需要采取其他方法来产生免疫力。
