826 Analyzing the Efficacy of Standard Hepatitis A and B Vaccination Schedules in HIV/HCV Co-infected Patients L. E. Taylor1, A. Lai*2, B. Schwartzapfel1, S. E. Reinert1, K. T. Tashima1, J. D. Rich1 1Miriam Hosp, Providence, RI and 2Brown Univ Sch of Med, Providence, RI
Background: Current CDC and USPHS/IDSA guidelines recommend vaccinations against hepatitis A virus (HAV) and hepatitis B virus (HBV) in susceptible HIV/hepatitis C virus (HCV) co-infected persons. While previous studies have suggested reduced immunogenicity to both vaccines in HIV-infected individuals and those with chronic HCV, few if any data exist on the immunological responses of co-infected patients (pts). It is unknown how other factors, such as pt demographics and immune status, may affect responses. We are unaware of previous evaluation of current HAV and HBV vaccinations in co-infected individuals. We performed a pilot study to determine what factors (age, race, gender, CD4 count, HIV viral load, HCV status, smoking status, and number of days from last vaccine shot to antibody testing) are significantly associated with a negative protective antibody response (either HAV Ab- or HBsAb-).
Methods: A retrospective chart review was performed. From 7-1-02 to 8-22-02, all HIV+ pts at the Miriam Hospital's Immunology Center previously immunized against HAV and/or HBV who attended their appointments were approached to submit blood for HAV antibody and/or HBV surface antibody testing.
Results: Of those vaccinated for HAV,15/15 (100%) pts consented to give a specimen; 10/15 (67%) were HAV Ab- and 5/15 (33%) were HAV Ab+. Of the 13 individuals with documented CD4 counts, logistic regression analysis showed that the mean CD4 count of 264 for the 8 HAV Ab- pts was significantly lower than the mean CD4 of 708 for the 5 HAV Ab+ subjects (n = 13, t = -5.12, p = 0.0003). Although this study was underpowered, both an older age (mean age 43 vs 37) and co-infection with HCV were associated with HAV Ab-. Race, gender, smoking status, number of days from last vaccination to antibody testing, and HIV PVL were not significantly associated with a negative antibody response. Of those pts vaccinated for HBV, 19/20 (95%) consented to give a specimen; 14/19 (74%) were HBsAb-, and 5/19 (26%) were HBsAb+. Statistical analysis demonstrated no significant associations of the examined factors with HBsAb-.
Conclusions: Co-infected individuals may have reduced immunogenicity to standard HAV and HBV vaccination schedules. Further research with a larger sample size and study power is needed. As this pt population is already at significant health risk due to end-stage liver disease, defining appropriate treatment guidelines, including optimal vaccination schedules, is critical.
