Background:  HIV patients are hyporesponsive to vaccination, including hepatitis B virus (HBV). CPG 7909 is an oligodeoxynucleotide-containing immunostimulatory CpG motif that directly activates, via TLR9, human B cells, and plasmacytoid dendritic cells. We previously reported rapid, higher, and sustained HBV seroprotection (to 36 months) and increased HBV-specific T-helper cell response in HIV subjects receiving Engerix-B +s 1 mg CPG 7909.

Methods:  A randomized, double-blind, controlled trial was conducted to determine clinical safety and HBV immunogenicity in adult HIV subjects on effective ART. HBV-susceptible subjects, half of whom had failed previous vaccination, were vaccinated at 0, 1, and 2 months with a double adult dose of Engerix-B ±1 mg CPG 7909 (n = 38). Seroprotective titres (anti-HBs titre ≥10 mIU/mL) at 6-month intervals until month 60 are reported. Missing values between measures were interpolated. Fisher exact test was used to generate the p-values using SPSS 13.0.

Results:  Geometric mean anti-HBs titres were higher in the CPG than placebo control adjuvant group at all measured time points. The proportion retaining seroprotective titres was greater in CPG 7909 recipients (see the table). The proportion retaining seroprotective titres was greater in CPG recipients for both prior vaccine failures and vaccine naļves. More CPG-Engerix subjects than controls had durable high-titre anti-HBs response (≥100 mIU/mL) at 36 (11 of 18 CPG vs 3 of 18 control, p = 0.02), 42 months (9 of 17 CPG vs 2 of 17 control, p = 0.03), and 48 (5 of 13 CPG vs 2 of 17 control, p = 0.19).

Conclusions:  The immunostimulatory properties of CPG 7909 present an important strategy in achieving long-term hepatitis B seroprotection in HBV vaccine hyporesponsive populations.