Piroth Lionel, Launay Odile, Michel Marie-Louise, Bourredjem Abderrahmane, Miailhes Patrick, Ajana Faiza, Chirouze Catherine, Zucman David, Wendling Marie-Josee, Nazzal Dani, Carrat Fabrice, Rey David, Binquet Christine
Département d'infectiologie, CHU de Dijon, MERS UMR1347, Université de Bourgogne, Dijon Cedex.
Université Paris Descartes, Sorbonne Paris Cité; INSERM, CIC 1417 , F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, CIC Cochin Pasteur.
J Infect Dis. 2016 Jun 1;213(11):1735-42. doi: 10.1093/infdis/jiw011. Epub 2016 Jan 14.
Although an isolated anti-hepatitis B virus (HBV) core antibody (anti-HBc) serological profile is frequent in human immunodeficiency virus (HIV)-infected patients, data on HBV vaccination in these patients are scarce.
A prospective multicenter study was conducted to assess the immunogenicity of HBV vaccination in 54 patients with an isolated anti-HBc profile and undetectable HIV load. They were vaccinated with 1 dose (20 µg) of recombinant HBV vaccine. Those with an anti-HBV surface antibody (anti-HBs) level of <10 mIU/mL 4 weeks after vaccination received 3 additional double doses (40 µg) at weeks 5, 9, and 24.
At week 4, 25 patients (46%) were responders. Only the ratio of CD4(+) T cells to CD8(+) T cells was associated with this response in multivariate analysis (odds ratio for +0.1, 1.32; 95% confidence interval, 1.07-1.63; P = .008). At week 28 and month 18, 58% of these patients (14 of 24) and 50% (10 of 20), respectively, maintained anti-HBs level of ≥10 mIU/mL.Among nonresponding patients at week 4, who received further vaccinations, 89% (24 of 27) and 81% (21 of 26) had an anti-HBs level of ≥10 mIU/mL at week 28 and month 18, respectively. The preS2-specific interferon γ T-cell response increased between week 0 and week 28 in patients who finally responded to reinforced vaccination (P = .03).
All of the patients with an isolated anti-HBc profile who did not have an anti-HBs titer of >100 mIU/mL 4 weeks after a single recall dose of HBV vaccine should be further vaccinated with a reinforced triple double-dose scheme.
尽管在人类免疫缺陷病毒（HIV）感染患者中，单纯抗乙肝病毒（HBV）核心抗体（抗-HBc）血清学特征较为常见，但关于这些患者乙肝疫苗接种的数据却很稀少。
开展了一项前瞻性多中心研究，以评估54例具有单纯抗-HBc特征且HIV载量检测不到的患者接种乙肝疫苗后的免疫原性。他们接种了1剂（20μg）重组乙肝疫苗。接种后4周时抗-HBV表面抗体（抗-HBs）水平<10 mIU/mL的患者在第5、9和24周额外接种3剂双剂量（40μg）疫苗。
在第4周时，25例患者（46%）有反应。多因素分析中，只有CD4(+)T细胞与CD8(+)T细胞的比例与这种反应相关（比值比为+0.1，1.32；95%置信区间，1.07-1.63；P = 0.008）。在第28周和第18个月时，这些患者中分别有58%（24例中的14例）和50%（20例中的10例）抗-HBs水平维持在≥10 mIU/mL。在第4周无反应的患者中，接受进一步接种后，分别有89%（27例中的24例）和81%（26例中的21例）在第28周和第18个月时抗-HBs水平≥10 mIU/mL。最终对强化接种有反应的患者，其前S2特异性干扰素γ T细胞反应在第0周和第28周之间有所增加（P = 0.03）。
所有具有单纯抗-HBc特征且在单次召回剂量乙肝疫苗接种后4周抗-HBs滴度未>100 mIU/mL的患者，均应采用强化三剂双剂量方案进一步接种疫苗。
