The Importance of Hepatitis B Immunization in HIV Patients

Hepatitis B tends to be more aggressive in HIV patients, increasing the risk of cirrhosis, end-stage liver disease, and hepatocellular cancer.

Coinfection with hepatitis B virus (HBV) isn’t uncommon among those infected with HIV.

The viruses share transmission mechanisms, explaining why 5% to 10% of HIV-infected patients have chronic HBV.

HBV’s course tends to be more aggressive in HIV patients; it increases the risk of cirrhosis, end-stage liver disease, and hepatocellular cancer. Clinicians urge HIV patients to be immunized against HBV in order to decrease the likelihood of infection.

Immunization for HBV doesn’t guarantee that patients will not develop HBV. Seroconversion—the time period during which antibody to the virus develops and becomes detectable in the blood—is the goal after vaccination, and seroconversion rates differ widely.

Optimally, patients will complete the vaccination series, but injection drug users are notoriously unreliable and often don’t return for the full series of shots.

A team of researchers recently investigated the serological response to HBV vaccination using standard schedule in HIV-positive patients. They evaluated characteristics that predict seroconversion. Their work, which was published ahead-of-print in the journal Vaccine, indicates that robust seroconversion rates are possible.

In this single-center prospective study, the researchers enrolled 245 HIV-positive adults and confirmed they hadn’t had HBV infection as evidenced by negative blood markers.

They conducted the study over 2 years and measured hepatitis B surface antibody titers 4 to 8 weeks after completion of vaccination schedule. They looked for associations between seroconversion and adherence to the HBV vaccination schedule.

At the study’s start, 80.7% of participants had undetectable HIV viral loads, 86.1% had CD4 counts >200, and 94.7% were on highly active antiretroviral therapy. This indicates that most participants had good control of their HIV.

Almost all participants (97.9%) completed the vaccination schedule. Sixty-two percent of participants seroconverted. Participants reported no adverse events whatsoever.

Those who were nonsmokers, younger than 45 years of age, and had CD4/CD8 ratios >0.4 (indicating good immune capability) were more likely to seroconvert. Eighty-six percent of these patients mounted the desired immune response.

The researchers indicated that CD4/CD8 ratio was the primary factor associated with positive serological conversion.