Preventive Medicine and Epidemiology Unit, Hospital Clínic, Barcelona, Spain.
Vaccine. 2013 Aug 12;31(36):3668-74. doi: 10.1016/j.vaccine.2013.06.012. Epub 2013 Jun 15.
HIV seropositivity is considered a risk factor for complications in hepatitis A virus (HAV) infection. HAV vaccination schedules are widely implemented in HIV-infected patients, but the immune response remains impaired.
We analysed the response to vaccination (antiHAV titres ≥20IU/l) in 282 HIV-infected patients included in a standard (1440 Elisa Units (EU) at 0, 6 months) or rapidly accelerated schedule (720 EU at 0, 7, 21 days and 6 months) between 1997 and 2009. Factors associated with the response to vaccination were analysed using logistic regression.
The overall response rate was 73.4%. Male sex (OR: 0.16, 95% CI 0.05-0.51) and hepatitis C virus co-infection (OR: 0.30, 95% CI 0.14-0.74) were associated with a lower probability of response. Protective antibody response was associated with a higher CD4/CD8 ratio (OR: 3.69, 95% CI 1.3-10.5) and having received two doses of standard schedule (compared with patients receiving only one dose of the same schedule) (OR: 2.51, 95% CI 1.22-5.15). Three doses of the rapidly accelerated schedule were not more effective than a single dose of 1440 EU (OR: 1.32, 95% CI 0.48-3.63).
The low responses observed in patients receiving a single dose suggest the need to emphasize adhesion to vaccination protocols to avoid failure. The CD4/CD8 ratio may be considered as an immune status marker which could help to better choose the moment of vaccination. Our findings underscore the importance of identifying strategies that optimize the timing and effectiveness of hepatitis A vaccination in HIV-infected patients and of the need for further studies on individual factors such as sex and hepatitis C co-infection that may affect the response to vaccination. Likewise, the sub-optimal effectiveness of three doses of 720 EU in the rapidly accelerated schedule, if confirmed in future studies, might lead to a revision of the current schedule recommended for HIV-infected travellers.
HIV 血清阳性被认为是甲型肝炎病毒（HAV）感染并发症的一个危险因素。广泛为 HIV 感染者制定了 HAV 疫苗接种计划，但免疫反应仍然受损。
我们分析了 282 名 HIV 感染者（1997 年至 2009 年间，他们接受了标准（0、6 个月时各 1440 个酶联免疫吸附单位（EU））或快速加速方案（0、7、21 天和 6 个月时各 720EU））接种疫苗后的反应（抗 HAV 滴度≥20IU/l）。使用逻辑回归分析与接种疫苗反应相关的因素。
总反应率为 73.4%。男性（比值比[OR]：0.16，95%置信区间[CI]：0.05-0.51）和丙型肝炎病毒合并感染（OR：0.30，95%CI：0.14-0.74）与较低的反应可能性相关。保护性抗体反应与较高的 CD4/CD8 比值（OR：3.69，95%CI：1.3-10.5）和接受两剂标准方案（与仅接受同一方案一剂的患者相比）（OR：2.51，95%CI：1.22-5.15）相关。与接受一剂 1440EU 的快速加速方案相比，接受三剂快速加速方案并没有更有效（OR：1.32，95%CI：0.48-3.63）。
接受一剂疫苗的患者观察到的低反应表明需要强调坚持疫苗接种方案，以避免失败。CD4/CD8 比值可被视为免疫状态标志物，有助于更好地选择接种疫苗的时机。我们的研究结果强调了确定策略的重要性，这些策略可以优化 HIV 感染者甲型肝炎疫苗接种的时间和效果，需要进一步研究性别和丙型肝炎合并感染等个体因素对疫苗接种反应的影响。同样，如果在未来的研究中证实，快速加速方案中三剂 720EU 的效果不理想，可能需要修订目前推荐给 HIV 感染者旅行者的方案。
