Background:  Hepatitis B virus (HBV) infection in HIV-infected patients is an increasing problem in the Western world. With the development of HAART, and with better survival rates, liver disease has become a leading cause of mortality. The response rate to HBV vaccine in HIV-infected patients is 24 to 60%, which is diminished comparing to immunocompetent hosts with rates of >90%. To achieve a higher response rate, we prospectively revaccinated all non-responders with high-dose recombinant HBV vaccine that failed at first series of vaccinations.

Methods:  In a prospective, open study all non-responders with anti-HBs titres <10 IU/L were revaccinated with double dose containing 20 µg HBV vaccine at monthly intervals. One month after the last vaccination, a blood sample was taken to perform quantitative anti-HBs testing. Univariate and multiple logistic regression analysis was used to determine factors that predicted success for HBV vaccination. The data analysis was performed using SPSS for Windows, release 11.0.1.

Results:  We revaccinated 135 patients, resulting in a 57.8% response rate. Predictors for successful response were younger age (p = 0.002, 95%CI 0.40 to 0.83), female gender (p = 0.03, 95%CI 1.08 to 6.19), and undetectable HIV RNA load (p = 0.005, 95%CI 1.37 to 6.96).

Conclusions:  It should be emphasized that to control antibody titres after a completed vaccination schedule in HIV-infected patients, as our study showed, additional revaccination is effective in 58% of cases.