In the Journals

HIV viremia, CD4 count determine response to hepatitis A vaccine

Nearly 4% of patients with HIV who received hepatitis A vaccinations during an outbreak demonstrated seroreversion, most of whom had HIV viremia and lower CD4 lymphocyte counts compared with those who achieved seroconversion, according to recently published data.

“Detectable or higher plasma HIV RNA load at the time of vaccination or the time of follow-up of antibody response has been reported in several studies, including ours, to be associated with poorer HAV vaccine durability,” Sung-Hsi Huang, MD, from the National Taiwan University Hospital, and colleagues wrote.

According to Huang and colleagues, an “unprecedented” outbreak of acute HAV occurred among men who have sex with men between June 2015 and December 2017 in Taiwan.

To investigate the incidence and correlated factors of HAV seroreversion among patients with HIV, the researchers enrolled 1,256 patients who demonstrated initial seroresponse from an HAV vaccination campaign launched after the outbreak.

“Understanding the predictors of HAV seroreversion after vaccination would inform the clinical guidance on serologic monitoring and the need of subsequent booster HAV vaccination in HIV-positive population,” the researchers wrote.

After a median follow-up of 611 days from the first dose of HAV vaccination, seroreversion of anti-HAV antibodies occurred in 3.9% of the cohort and in 6.8% of those with CD4 counts less than 350 cells/mm3.

Multivariate analysis showed that higher weight (adjusted OR = 1.703 per 10-kg increment; 95% CI, 1.292-2.323) and HIV RNA load higher than 200 copies/mL at the time of vaccination (aOR = 2.922; 95% CI, 1.067-7.294) correlated significantly with early seroreversion.

In contrast, positive anti-HAV seroresponse at 6 months (aOR = 0.059; 95% CI, 0.02-0.152) and higher CD4 lymphocyte counts at vaccination (aOR = 0.837 per 100-cell/mm3; 95% CI, 0.704-0.979) correlated inversely with early seroreversion.

“Despite well-documented effectiveness of hepatitis A vaccination, the coverage among people living with HIV remains poor in many parts of the world,” Huang and colleagues wrote. “Also, the lack of monitoring of serologic response after vaccination to evaluate the need for repeated or booster vaccination among HIV-positive individuals could result in a substantial number of susceptible hosts and the subsequent persistence of HAV transmission in the communities.”

The researchers advise that regular monitoring of seroresponse and booster vaccination after

primary HAV vaccination are warranted, especially among patients with HIV and risk factors identified in this study. – by Talitha Bennett

Disclosure: Huang reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Nearly 4% of patients with HIV who received hepatitis A vaccinations during an outbreak demonstrated seroreversion, most of whom had HIV viremia and lower CD4 lymphocyte counts compared with those who achieved seroconversion, according to recently published data.

“Detectable or higher plasma HIV RNA load at the time of vaccination or the time of follow-up of antibody response has been reported in several studies, including ours, to be associated with poorer HAV vaccine durability,” Sung-Hsi Huang, MD, from the National Taiwan University Hospital, and colleagues wrote.

According to Huang and colleagues, an “unprecedented” outbreak of acute HAV occurred among men who have sex with men between June 2015 and December 2017 in Taiwan.

To investigate the incidence and correlated factors of HAV seroreversion among patients with HIV, the researchers enrolled 1,256 patients who demonstrated initial seroresponse from an HAV vaccination campaign launched after the outbreak.

“Understanding the predictors of HAV seroreversion after vaccination would inform the clinical guidance on serologic monitoring and the need of subsequent booster HAV vaccination in HIV-positive population,” the researchers wrote.

After a median follow-up of 611 days from the first dose of HAV vaccination, seroreversion of anti-HAV antibodies occurred in 3.9% of the cohort and in 6.8% of those with CD4 counts less than 350 cells/mm3.

Multivariate analysis showed that higher weight (adjusted OR = 1.703 per 10-kg increment; 95% CI, 1.292-2.323) and HIV RNA load higher than 200 copies/mL at the time of vaccination (aOR = 2.922; 95% CI, 1.067-7.294) correlated significantly with early seroreversion.

In contrast, positive anti-HAV seroresponse at 6 months (aOR = 0.059; 95% CI, 0.02-0.152) and higher CD4 lymphocyte counts at vaccination (aOR = 0.837 per 100-cell/mm3; 95% CI, 0.704-0.979) correlated inversely with early seroreversion.

“Despite well-documented effectiveness of hepatitis A vaccination, the coverage among people living with HIV remains poor in many parts of the world,” Huang and colleagues wrote. “Also, the lack of monitoring of serologic response after vaccination to evaluate the need for repeated or booster vaccination among HIV-positive individuals could result in a substantial number of susceptible hosts and the subsequent persistence of HAV transmission in the communities.”

The researchers advise that regular monitoring of seroresponse and booster vaccination after

primary HAV vaccination are warranted, especially among patients with HIV and risk factors identified in this study. – by Talitha Bennett

Disclosure: Huang reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.