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Clinical Trial
. 2010 Aug 2;28(34):5597-604.
doi: 10.1016/j.vaccine.2010.06.030. Epub 2010 Jun 23.

Immune response to hepatitis B vaccine in HIV-infected subjects using granulocyte-macrophage colony-stimulating factor (GM-CSF) as a vaccine adjuvant: ACTG study 5220

E T Overton  1 , M Kang, M G Peters, T Umbleja, B L Alston-Smith, B Bastow, D Demarco-Shaw, M J Koziel, L Mong-Kryspin, H L Sprenger, J Y Yu, J A Aberg
Affiliations
Clinical Trial

Immune response to hepatitis B vaccine in HIV-infected subjects using granulocyte-macrophage colony-stimulating factor (GM-CSF) as a vaccine adjuvant: ACTG study 5220

E T Overton et al. Vaccine. .

Abstract

HIV-infected persons are at risk for HBV co-infection which is associated with increased morbidity and mortality. Unfortunately, protective immunity following HBV vaccination in HIV-infected persons is poor. This randomized, phase II, open-label study aimed to evaluate efficacy and safety of 40 mcg HBV vaccine with or without 250 mcg GM-CSF administered at day 0, weeks 4 and 12. HIV-infected individuals >or=18 years of age, CD4 count >or=200 cells/mm(3), seronegative for HBV and HCV, and naïve to HBV vaccination were eligible. Primary endpoints were quantitative HBsAb titers and adverse events. The study enrolled 48 subjects. Median age and baseline CD4 were 41 years and 446 cells/mm(3), 37 were on ART, and 26 subjects had undetectable VL. Vaccination was well tolerated. Seven subjects in the GM-CSF arm reported transient grade >or=2 signs/symptoms (six grade 2, one grade 3), mostly aches and nausea. GM-CSF had no significant effect on VL or CD4. Four weeks after vaccination, 26 subjects (59%) developed a protective antibody response (HBsAb >or=10 mIU/mL; 52% in the GM-CSF arm and 65% in the control arm) without improved Ab titer in the GM-CSF vs. control arm (median 11 mIU/mL vs. 92 mIU/mL, respectively). Response was more frequent in those with CD4 >or=350 cells/mm(3) (64%) than with CD4 <350 cells/mm(3) (50%), though not statistically significant. GM-CSF as an adjuvant did not improve the Ab titer or the development of protective immunity to HBV vaccination in those receiving an accelerated vaccine schedule. Given the common routes of transmission for HIV and HBV, additional HBV vaccine research is warranted.

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Conflict of interest statement

Potential conflicts of interest. ETO received research grants from Merck, GlaxoSmithKline, Gilead, Abbott, Tibotec, and Boehinger Ingelheim through Washington University; served as a consultant for Tibotec and GlaxoSmithKline; and served on speakers’ bureau or received honoraria from Merck, Tibotec, GlaxoSmithKline, Bristol-Myers Squibb, GlaxoSmithKline, Monogram Sciences, and Gilead. JA has received honoraria, research support and/or served on the advisory boards of Abbott Laboratories, Boehringer Ingelheim, Bristol Myers Squib, Gilead Sciences, Glaxo-Smith Kline, Merck & Co., Inc., Pfizer, Inc, Schering-Plough and Tibotec Therapeutics. MP has served as a consultant for Merck, Pharmasset, Cinical Care Options and Hoffman LaRoche. All other authors: no conflicts.

Figures

Figure 1
Figure 1. Subjects Developing Protective Ab (HBsAb ≥ 10 mIU/mL)
Proportion of subjects by study arm who developed protective immunity (HBsAb ≥ 10 mIU/mL) at various time points during the study.
Figure 2
Figure 2. HBsAb Titer by Arm at Study Visits
Log10 HBV sAb titer by study arm at various time points during the study.
See this image and copyright information in PMC

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