Nicolini Laura Ambra, Magne Federica, Signori Alessio, Di Biagio Antonio, Sticchi Laura, Paganino Chiara, Durando Paolo, Viscoli Claudio
1 Department of Health Sciences (DISSAL), University of Genoa , Genoa, Italy .
2 Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy .
AIDS Res Hum Retroviruses. 2018 Nov;34(11):922-928. doi: 10.1089/AID.2017.0070. Epub 2018 Aug 16.
Vaccination against hepatitis B virus (HBV) is recommended in people living with HIV (PLHIV), although immune response rates are lower than in healthy individuals. We aimed at assessing response rates and predictors as well as persistence of seroprotection in a cohort of PLHIV with no serological evidence of current or previous HBV infection. PLHIV followed at our site were retrospectively included if they started a primary HBV vaccination course (20 mcg three-dose schedule, alone or combined with inactivated hepatitis A virus) between 2007 and 2012. Serological response was defined as hepatitis B surface antibodies (HBsAb) ≥10 IU/liter 4 to 24 weeks after the third vaccine dose. Among 134 patients included, 119 completed the primary HBV vaccination schedule. Of them, 68% developed serological response. HIV viral suppression was associated with HBsAb ≥10 IU/liter [OR (odds ratio) 0.52, 95% confidence interval (CI) 0.33-0.82, p = .005], whereas CD4-T cell count was not (OR 1.001, 95% CI 1.001-1.003, p = .1). HBsAb titer declined over time, since 69.3% and 26.9% of vaccinees had HBsAb ≥10 IU/liter 36 and 84 months after the third HBV vaccine dose. Time-updated CD4-T cell count was associated with persistence of seroprotection [HR (hazard ratio) 1.17, 95% CI 1.06-1.30, p = .003], independently from quantitative HBV surface antigen titer achieved at the end of the primary vaccination schedule (HR 1.02, 95% CI 0.96-1.08, p = .64). The longer the time interval from vaccination, the higher the risk of loss of seroprotection. Repeating HBsAb titer 5 years after a successful HBV vaccination may be used to guide booster vaccination, as the majority of subjects may no longer have seroprotective HbsAb titers.
尽管与健康个体相比，艾滋病毒感染者（PLHIV）的免疫应答率较低，但仍建议对其进行乙型肝炎病毒（HBV）疫苗接种。我们旨在评估一组无当前或既往HBV感染血清学证据的PLHIV的应答率、预测因素以及血清保护的持续性。如果在2007年至2012年期间开始原发性HBV疫苗接种疗程（20微克三剂方案，单独或与甲型肝炎病毒灭活疫苗联合使用），则回顾性纳入在我们机构接受随访的PLHIV。血清学应答定义为在第三剂疫苗接种后4至24周时乙型肝炎表面抗体（HBsAb）≥10国际单位/升。在纳入的134例患者中，119例完成了原发性HBV疫苗接种方案。其中，68%出现了血清学应答。HIV病毒抑制与HBsAb≥10国际单位/升相关[比值比（OR）0.52，95%置信区间（CI）0.33 - 0.82，p = 0.005]，而CD4-T细胞计数则不然（OR 1.001，95% CI 1.001 - 1.003，p = 0.1）。HBsAb滴度随时间下降，因为在第三剂HBV疫苗接种后36个月和84个月时，分别有69.3%和26.9%的疫苗接种者HBsAb≥10国际单位/升。随时间更新的CD4-T细胞计数与血清保护的持续性相关[风险比（HR）1.17，95% CI 1.06 - 1.30，p = 0.003]，独立于原发性疫苗接种方案结束时达到的定量HBV表面抗原滴度（HR 1.02，95% CI 0.96 - 1.08，p = 0.64）。从接种疫苗开始的时间间隔越长，血清保护丧失的风险越高。在成功接种HBV疫苗5年后重复检测HBsAb滴度可用于指导加强疫苗接种，因为大多数受试者可能不再具有血清保护性的HbsAb滴度。
