Chatkittikunwong Garnpawee, Khawcharoenporn Thana
Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Int J STD AIDS. 2016 Sep;27(10):850-5. doi: 10.1177/0956462415596498. Epub 2015 Jul 15.
Limited data exist on hepatitis B revaccination strategies for HIV-infected individuals who do not develop immunity after the first vaccination series. A retrospective cohort study was conducted to assess the immunogenicity of the second series of hepatitis B vaccine given in standard dosing (SD) and double dosing (DD) strategies among Thai HIV-infected adults during the period from January 2006 to December 2014. Of the 120 eligible patients, 68 (57%) were men, median age was 38 years old, 87 (73%) received SD and 33 (27%) received DD revaccination. The demographic and clinical characteristics of SD and DD groups were comparable. The overall vaccine response rate was significantly higher in DD group than SD group (97% vs. 70%; p = 0.001). Independent factors associated with no response to hepatitis B revaccination were receipt of SD vaccine (adjusted odds ratio [aOR] 16.04; p = 0.009), age ≥ 40 years (aOR 3.66; p = 0.009) and CD4 cell count at the time of revaccination less than 450 cells/µL (aOR 2.96; p = 0.04). These findings suggest that DD hepatitis B revaccination series should be given in HIV-infected patients who were at least 40 years old or had CD4 counts less than 450 cells/µL after no response to the first vaccination series.
对于首次接种乙肝疫苗后未产生免疫力的HIV感染者，乙肝再接种策略方面的数据有限。开展了一项回顾性队列研究，以评估2006年1月至2014年12月期间，泰国成年HIV感染者采用标准剂量（SD）和双倍剂量（DD）策略进行第二次乙肝疫苗接种的免疫原性。在120例符合条件的患者中，68例（57%）为男性，中位年龄为38岁，87例（73%）接受了SD再接种，33例（27%）接受了DD再接种。SD组和DD组的人口统计学和临床特征具有可比性。DD组的总体疫苗应答率显著高于SD组（97%对70%；p = 0.001）。与乙肝再接种无应答相关的独立因素包括接受SD疫苗接种（调整后的优势比[aOR]为16.04；p = 0.009）、年龄≥40岁（aOR为3.66；p = 0.009）以及再接种时CD4细胞计数低于450个/µL（aOR为2.96；p = 0.04）。这些发现表明，对于首次接种疫苗无应答且年龄至少40岁或再接种时CD4细胞计数低于450个/µL的HIV感染患者，应采用DD乙肝再接种方案。
