884
Strategies for Management and Optimization of Response to Hepatitis B Vaccination in HIV Patients
S Low, A Prior, B Mooka, S Clarke, Fiona Mulcahy*, and C Bergin
St James's Hosp, Dublin, Ireland
Background: Previous studies have shown response rates to hepatitis B
virus (HBV) vaccine in HIV– patients to be ~90% and in HIV+
patients to be <50%, but data have also shown a wide variation in completion
rates (30 to 85%). This study aims to identify the effectiveness of strategies
employed to ensure high vaccination completion and response rate in HIV+.
Strategies focused on patient education, establishment of a designated unit
with a full-time vaccination nurse, patient reminder system (including mobile
phone SMS), and double-dosing regimen.
Methods: An audit of all the patients recruited into the HBV
vaccination program from the January 1, 2003 until December 31, 2005 was performed to identify
the patients based on their HIV status, risk categories, gender, and age from the
HIV and sexually transmitted infection (STI) clinics, using HIV–
patients as controls. The data identify patients with the highest incomplete
vaccination as the target of new recall strategies. These are either due to
serological non-response or patient non-attendance for completion of vaccine
series. Double dosing was introduced in 2005 for HIV+ non-responders
and SMS recall services in 2006 with the aim of improving the completion rates.
Results: From the 2005 data (see the tables), 13 of the 15 double-dosing
patients seroconverted, all of whom have CD4 >500; the remaining 2 had CD4 <500.
Conclusions: HBV vaccination completion rate (see graph) is higher among
HIV+ patients than HIV– patients (75% vs 68%), higher
among females (irrespective of HIV status), and is independent of age. With
double dosing, the 87% seroconversion rate is higher than past data show (64%).
Higher CD4 count is associated with better seroconversion outcome in both the
standard vaccination and the double-dosing series, in keeping with previous
studies. The SMS reminder system was introduced in 2006 to improve vaccination
completion rate.
|
|
Received 1st
Shot
|
Received 2nd
Shot
|
Received 3rd
Shot
|
|
HIV+
|
253
|
221
|
191
|
|
HIV–
|
294
|
233
|
220
|
|
Total
Patients
|
547
|
456
|
391
|
|
|
Female
|
Male
|
Heterosexual
|
Injection
Drug User
|
MSM
|
Other Risks
|
|
HIV+
|
79
|
72
|
80
|
76
|
66
|
40
|
|
HIV–
|
73
|
67
|
83
|
42
|
68
|
71
|
Percentage of
Vaccine Completion by Gender and Risk Groups
2003-2005
Vaccination Outcome (HIV+ Cohort), n = 191
|
