Schnyder Jenny L, Garcia Garrido Hannah M, Maurer Irma, Harskamp Agnes M, Kootstra Neeltje A, Grobusch Martin P, Goorhuis Abraham
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Experimental Immunology, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Open Forum Infect Dis. 2025 Sep 15;12(9):ofaf457. doi: 10.1093/ofid/ofaf457. eCollection 2025 Sep.
Hepatitis A (hepA) vaccination generates long-lasting protection against hepA in healthy adults. However, the duration of protection in immunocompromised patients (ICPs), such as people living with HIV (PLWH) and patients on immunosuppressive therapy, is uncertain.
This 3-year follow-up study of a prospective cohort assessed hepA antibodies in PLWH, patients on immunosuppressive therapy, and controls after completing a full hepA vaccination series. Three years later (Y3), serum samples were collected in 88/150 (59%) of original participants. The primary outcome was the seroprotection rate (SPR) at Y3, defined as the proportion of participants with hepA antibodies ≥20 mIU/mL. Secondary outcomes included seroreversion rates, defined as the proportion of those unprotected at Y3, among those initially protected after the primary vaccination schedule, and geometric mean concentrations (GMCs) at Y3.
At Y3, SPRs were 87% (20/23) in PLWH, 90% (26/29) in patients on immunosuppressive monotherapy, 65% (13/20) in patients on immunosuppressive combination therapy, and 100% (16/16) in controls. Seroreversion rates were 13% (3/23) in PLWH, 10% (3/29) in patients on immunosuppressive monotherapy, 21% (4/19) in patients on immunosuppressive combination therapy, and 0% (0/16) in controls. GMCs in ICPs (41.13-70.75 mIU/mL) were significantly lower compared to controls (175.65 mIU/mL) (-value = .001).
Three years postvaccination, most ICPs remained seroprotected, but SPRs and GMCs were lower than in healthy controls, particularly in patients on combination immunosuppressive therapy. However, it remains uncertain if booster doses are necessary among those who seroreverted, as long-term protection may persist through formed cellular memory.
甲型肝炎（hepA）疫苗接种可为健康成年人提供针对甲型肝炎的长期保护。然而，免疫功能低下患者（ICPs），如艾滋病毒感染者（PLWH）和接受免疫抑制治疗的患者，其保护持续时间尚不确定。
这项对前瞻性队列进行的为期3年的随访研究，在完成完整的甲型肝炎疫苗接种系列后，评估了艾滋病毒感染者、接受免疫抑制治疗的患者以及对照组中的甲型肝炎抗体。三年后（Y3），在150名原始参与者中的88名（59%）中采集了血清样本。主要结局是Y3时的血清保护率（SPR），定义为甲型肝炎抗体≥20 mIU/mL的参与者比例。次要结局包括血清逆转率，定义为在初次接种疫苗后最初受到保护的人群中，Y3时未受保护者的比例，以及Y3时的几何平均浓度（GMCs）。
在Y3时，艾滋病毒感染者的血清保护率为87%（20/23），接受免疫抑制单一疗法的患者为90%（26/29），接受免疫抑制联合疗法的患者为65%（13/20），对照组为100%（16/16）。艾滋病毒感染者的血清逆转率为13%（3/23），接受免疫抑制单一疗法的患者为10%（3/29），接受免疫抑制联合疗法的患者为21%（4/19），对照组为0%（0/16）。免疫功能低下患者的几何平均浓度（41.13 - 70.75 mIU/mL）显著低于对照组（175.65 mIU/mL）（P值 = .001）。
疫苗接种三年后，大多数免疫功能低下患者仍保持血清保护状态，但血清保护率和几何平均浓度低于健康对照组，尤其是接受联合免疫抑制治疗的患者。然而，对于血清逆转者是否需要加强剂量仍不确定，因为长期保护可能通过形成的细胞记忆持续存在。
