Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
Hepatology. 2019 Aug;70(2):465-475. doi: 10.1002/hep.30495. Epub 2019 Feb 14.
Serological responses (Seroresponse) and durability of hepatitis A virus (HAV) vaccination are reduced among human immunodeficiency virus (HIV)-positive patients. Incidence of and associated factors with early seroreversion (loss of seroresponse) among HIV-positive patients who have achieved seroresponses after two doses of HAV vaccination remain unclear. In this multicenter study, we followed HIV-positive adults who had mounted seroresponses after completing two doses of HAV vaccination during a recent outbreak of acute hepatitis A between 2015 and 2017, a 1:4 case-control study was conducted to identify factors associated with seroreversion. Case patients were those with seroreversion, and controls were those with similar follow-up durations who were able to maintain seroresponses. During the study period, 49 of the 1,256 patients (3.9%) seroreverted after a median follow-up of 611 days. In a case-control study, seroreversion was more likely to occur in patients with a higher weight (adjusted odds ratio [aOR], 1.703; 95% confidence interval [CI], 1.292-2.323, per 10-kg increment) and HIV viremia at the time of vaccination (aOR, 2.922; 95% CI, 1.067-7.924), whereas positive seroresponse at 6 months of HAV vaccination and higher CD4 lymphocyte counts at vaccination were inversely associated with early seroreversion with an aOR of 0.059 (95% CI, 0.020-0.154) and 0.837 (95% CI, 0.704-0.979, per 100-cell/mm increment), respectively, in multivariable analyses. Conclusion: During an outbreak setting, early seroreversion following two-dose HAV vaccination occurred in 3.9% of HIV-positive patients. Lower and delayed seroresponses to HAV vaccination, a higher weight, and HIV viremia and lower CD4 lymphocyte counts at the time of HAV vaccination were associated with early seroreversion. Regular monitoring of seroresponse and booster vaccination might be warranted, especially in HIV-positive adults with predictors of early seroreversion.
血清学应答（Seroresponse）和甲型肝炎病毒（HAV）疫苗的持久性在人类免疫缺陷病毒（HIV）阳性患者中降低。在 HIV 阳性患者中，两剂 HAV 疫苗接种后达到血清应答的患者中，早期血清学转换（失去血清应答）的发生率和相关因素仍不清楚。在这项多中心研究中，我们对 2015 年至 2017 年急性甲型肝炎爆发期间完成两剂 HAV 疫苗接种后产生血清应答的 HIV 阳性成年人进行了随访，进行了 1:4 的病例对照研究，以确定与血清学转换相关的因素。病例患者为血清学转换患者，对照组为具有相似随访时间且能够维持血清应答的患者。在研究期间，在中位随访 611 天后，1256 例患者中有 49 例（3.9%）发生血清学转换。在病例对照研究中，体重较高的患者（调整后的优势比[aOR]，1.703；95%置信区间[CI]，1.292-2.323，每增加 10 公斤）和接种时 HIV 病毒血症的患者更有可能发生血清学转换（aOR，2.922；95%CI，1.067-7.924），而 HAV 疫苗接种后 6 个月的阳性血清反应和较高的 CD4 淋巴细胞计数与早期血清学转换呈负相关，调整后的比值比（aOR）分别为 0.059（95%CI，0.020-0.154）和 0.837（95%CI，0.704-0.979，每增加 100 个细胞/mm），在多变量分析中。结论：在暴发环境中，两剂 HAV 疫苗接种后 HIV 阳性患者中有 3.9%发生早期血清学转换。HAV 疫苗接种时较低和延迟的血清反应、较高的体重以及 HIV 病毒血症和 CD4 淋巴细胞计数较低与早期血清学转换相关。可能需要定期监测血清反应并进行加强免疫接种，特别是在有早期血清学转换预测因素的 HIV 阳性成年人中。
