Lapphra Keswadee, Angkhananukit Paveena, Saihongthong Supawan, Phongsamart Wanatpreeya, Wittawatmongkol Orasri, Rungmaitree Supattra, Chokephaibulkit Kulkanya
From the *Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Pediatr Infect Dis J. 2017 Sep;36(9):863-868. doi: 10.1097/INF.0000000000001613.
HIV infection may alter immunologic response and the establishment of immune memory to infant hepatitis B virus (HBV) vaccination. This study aimed to determine the need to revaccinate perinatally HIV-infected Thai adolescents.
Cross-sectional serologic tests for HBV, including hepatitis B surface antigen, anti-hepatitis B surface antibody (anti-HBs) and anti-hepatitis B core antibody (anti-HBc), were performed in perinatally HIV-infected adolescents. Adolescents having anti-HBs <100 mIU/mL with negative anti-HBc and immune reconstitution from highly active antiretroviral therapy (HAART) were revaccinated using regular (10 μg) 3-dose schedule given intramuscularly at 0-, 2- and 6-month intervals.
Of 193 adolescents who received 3-dose infant HBV vaccination, 6 were receiving HAART during vaccination, median (interquartile range) current age 14.5 (11.7-16.2) years, 7 (3.6%) had positive anti-HBc (indicating breakthrough infection), of which 4 (2%) had positive hepatitis B surface antigen (indicating chronic infection). Twenty-two (11.4%) adolescents had protective anti-HBs concentration >10 mIU/mL. Of 164 revaccinated adolescents, 142 (86.6%) had HIV viral load <40 copies/mL. Anti-HBs seroconversion rates >10 mIU/mL were 58.0% (94/162) after the first dose and 97.5% (158/162) after the third dose of revaccination. Forty-five (28%) subjects responded to the first dose with anti-HBs antibody ≥100 mIU/mL had a shorter median duration with CD4 count <15% than their counterparts (6.2 vs. 11.1 months; P = 0.049).
Only half of perinatally HIV-infected adolescents were able to elicit anti-HBs response with a single-dose HBV vaccine. Revaccination with 3-dose schedule is required in perinatally HIV-infected adolescents who did not initiate HAART at the time of infant vaccination.
HIV感染可能会改变免疫反应以及对婴儿乙肝病毒（HBV）疫苗接种的免疫记忆建立。本研究旨在确定对围产期感染HIV的泰国青少年进行再次接种疫苗的必要性。
对围产期感染HIV的青少年进行了乙肝病毒的横断面血清学检测，包括乙肝表面抗原、乙肝表面抗体（抗-HBs）和乙肝核心抗体（抗-HBc）。抗-HBs<100 mIU/mL且抗-HBc阴性并从高效抗逆转录病毒治疗（HAART）中实现免疫重建的青少年，按照常规（10μg）3剂次方案进行再次接种，分别在0、2和6个月间隔进行肌肉注射。
在193名接受3剂次婴儿乙肝疫苗接种的青少年中，6人在接种疫苗期间接受HAART治疗，当前年龄中位数（四分位间距）为14.5（11.7-16.2）岁，7人（3.6%）抗-HBc呈阳性（表明有突破性感染），其中4人（2%）乙肝表面抗原呈阳性（表明慢性感染）。22名（11.4%）青少年的保护性抗-HBs浓度>10 mIU/mL。在164名再次接种疫苗的青少年中，142人（86.6%）的HIV病毒载量<40拷贝/mL。再次接种第一剂后抗-HBs血清转化率>10 mIU/mL为58.0%（94/162），第三剂后为97.5%（158/162）。45名（28%）首次接种时抗-HBs抗体≥100 mIU/mL的受试者，其CD4细胞计数<15%的中位持续时间短于未达到该抗体水平的受试者（6.2对11.1个月；P=0.049）。
只有一半的围产期感染HIV的青少年能够通过单剂量乙肝疫苗引发抗-HBs反应。在婴儿接种疫苗时未开始HAART治疗的围产期感染HIV的青少年需要按照3剂次方案进行再次接种。
