Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
Liver Int. 2018 Nov;38(11):1920-1929. doi: 10.1111/liv.13721. Epub 2018 Mar 12.
Serological responses to revaccination against hepatitis B virus (HBV) are unclear in HIV-positive adults who had undergone neonatal HBV vaccination and whose antibodies against HBV had waned in the era of combination antiretroviral therapy (cART).
Between 2000 and 2017, 666 HIV-positive men who have sex with men (MSM) who were born after 1986, when nationwide neonatal HBV vaccination programme was implemented in Taiwan, were included for analyses. A serological response was defined when a hepatitis B surface antibody (anti-HBs) titre ≥10 mIU/mL was measured 4-24 weeks after the third dose of HBV vaccination.
During the study period, 295 (48.7%) HIV-positive MSM (mean age, 23.2 years) who had lost HBV seroprotection were eligible for revaccination; 171 (58.0%) received at least 1 dose (20-μg) of HBV vaccine and 116 (39.3%) completed the 3-dose schedule. The serological response rate to 3 doses of HBV revaccination was 74.0% and the rate of high-titre response (anti-HBs titre ≥100 mIU/mL) was 46.0%. The CD4 count before the first dose (per 50-cell/μL increment, adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.29) was positively associated with the serological response. The incident rate of HBV infection was 9.2 per 1000 person-years of follow-up among the patients who were non-responders after revaccination.
Despite HBV vaccination in the neonatal period, the serological response rate to HBV revaccination in HIV-positive MSM was modest and could wane rapidly. Regular testing of anti-HBs should be integrated into the HIV care despite cART containing HBV-active agents.
在接受过乙型肝炎病毒（HBV）新生儿疫苗接种且在联合抗逆转录病毒治疗（cART）时代其 HBV 抗体减弱的 HIV 阳性成年人中，针对 HBV 再接种的血清学反应尚不清楚。
在 2000 年至 2017 年间，纳入了 666 名 1986 年后出生的、曾在台湾实施全国性新生儿 HBV 疫苗接种计划时出生的 HIV 阳性男男性行为者（MSM）进行分析。当在 HBV 疫苗接种后 4-24 周测量到乙型肝炎表面抗体（抗-HBs）滴度≥10 mIU/mL 时，定义为血清学反应。
在研究期间，295 名（48.7%）失去 HBV 血清保护的 HIV 阳性 MSM（平均年龄 23.2 岁）有资格接受再接种；171 名（58.0%）至少接受了 1 剂（20-μg）HBV 疫苗，116 名（39.3%）完成了 3 剂接种。3 剂 HBV 再接种的血清学反应率为 74.0%，高滴度反应率（抗-HBs 滴度≥100 mIU/mL）为 46.0%。第 1 剂前的 CD4 计数（每增加 50 个细胞/μL，调整后的优势比，1.14；95%置信区间，1.01-1.29）与血清学反应呈正相关。再接种后无反应者的 HBV 感染发生率为每 1000 人年 9.2 例。
尽管在新生儿期进行了 HBV 疫苗接种，但 HIV 阳性 MSM 对 HBV 再接种的血清学反应率较低，且可能迅速减弱。尽管 cART 中含有 HBV 活性药物，但应将抗-HBs 的定期检测纳入 HIV 护理中。
