Impaired responsiveness of homosexual men with HIV antibodies to plasma derived hepatitis B vaccine

Abstract

Thirty five homosexual men (17 positive for antibody to the human immunodeficiency virus (HIV) and 18 consistently negative) were vaccinated against hepatitis B virus infection. Eight of the 17 seropositive patients failed to develop detectable hepatitis B surface antibody within three months of the third injection compared with only one of the 18 seronegative patients (p less than 0.01). HIV infection is prevalent in the developed world in groups at risk for hepatitis B infection and in certain Third World countries where widespread vaccination programmes exist. This study shows the impact that coincident HIV infection may have on an otherwise efficacious vaccine. The efficacy of this and other vaccines in patients infected with HIV needs to be studied urgently.

PIP: The human immunodefiency virus (HIV) affects polyclonal B cell activation and impairs in vitro B cell response to mitogens and antigens, and in vivo primary humoral response. 35 homosexual men, 17 of whom were positive for antibodies to HIV and 18 consistently negative, were vaccinated against hepatitis B virus infection. All were screened for sexually transmitted diseases and hepatitis antigens and found to be negative. 8 of the seropositive patients failed to develop detectable hepatitis B surface antibody within 3 months of the 3rd injection compared with only 1 of the seronegative patients (p0.01). HIV infection is prevalent in the developed world in groups at risk for hepatitis B infection and certain developing countries where widespread vaccination programs exist. Vaccination programs target younger populations especially, and these populations are now heavily at risk for HIV infection through neonatal transmission. This study shows the impact that coincident HIV infection may have on an otherwise efficacious vaccine. It might be necessary to perform frequent vaccinations and to inject vaccines into the arm, which has been shown to be more effective. The efficacy of this and other vaccines, especially live vaccines, in patients infected with HIV needs to be studied urgently.