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SEROCONVERSION RATES IN HIV-POSITIVE CHILDREN AND ADOLESCENTS RECEIVING DOUBLE DOSE HEPATITIS B VACCINE AFTER INITIAL NON-RESPONSE TO STANDARD REGIMEN

Wednesday, 25th of July 2012

 

• SEROCONVERSION RATES IN HIV-POSITIVE CHILDREN AND ADOLESCENTS RECEIVING DOUBLE DOSE HEPATITIS B VACCINE AFTER INITIAL NON-RESPONSE TO STANDARD REGIMEN 

Presented by Katherine Dickman Dobbs (United States).

K. Dickman Dobbs¹, C. Moloney², E.R. Cooper<sup>2

1</sup>Boston Medical Center, Pediatrics, Boston, United States, ²Boston Medical Center, Pediatric Infectious Diseases, Boston, United States

Also accessible at http://pag.aids2012.org/abstracts.aspx?aid=1146 

Background: Co-infection with hepatitis B virus (HBV) is an important cause of morbidity and mortality for HIV-infected patients. Compared to the HIV-uninfected population, children with HIV have shown lower rates of seroconversion after receiving the HBV vaccine series, varying from 20-78%, in comparison to 95-99%. Revaccination with double dose (DD) HBV vaccine has been shown to improve seroconversion rates in some populations, including those on hemodialysis and HIV-infected adults with high CD4 counts and relative viral suppression.

Methods: Our pediatric HIV clinic instituted a quality improvement measure in which patients who had not responded to initial standard dose vaccine series or subsequent booster doses (defined as HBsAb< 10 IU/L) were administered a three-dose series of DD HBV vaccine for age, at intervals of no less than 8 weeks. HBsAb levels were measured after first, second, and third DD. Baseline clinical characteristics were compared between responders and non-responders to the DD series.

Results: Sixty of 99 patients previously immunized with HBV (60.6%) were identified as having HBsAb levels < 10 IU/L after chart review. As of February 2012, 54 of these 60 have had one or more DD. The seroconversion rate after receiving one or more DD was 65.7%. As compared to non-responders, responders were younger (15.4 vs. 19.1 years, p=0.04), had lower average BMI (22.8 vs. 26.6 kg/m², p=0.04), higher CD4 counts (766 vs. 487 cells/mm³, p=0.02), higher CD4 percentages (31.5% vs. 21.9%, p=0.004), and lower median viral loads (75 vs. 1491 copies/ml, p=0.05).
Conclusions: Revaccination using DD HBV vaccine improves seroconversion rates among HIV-infected children and adolescents with previous non-response to standard dose series. Investigation is needed to determine if this would be an effective first strategy, or if its success represents a booster effect suggesting past memory. Further study is needed for development of policy regarding immunization against HBV in HIV-infected children.