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. 2021 Feb 22;39(8):1265-1271.
doi: 10.1016/j.vaccine.2021.01.043. Epub 2021 Jan 28.

Immune response to the hepatitis B vaccine among HIV-infected adults in Uganda

E Seremba  1 , P Ocama  2 , R Ssekitoleko  2 , H Mayanja-Kizza  2 , S V Adams  3 , J Orem  4 , E Katabira  2 , S J Reynolds  5 , R Nabatanzi  6 , C Casper  7 , W Phipps  8
Affiliations

Immune response to the hepatitis B vaccine among HIV-infected adults in Uganda

E Seremba et al. Vaccine. .

Abstract

Background: Co-infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is common in sub-Saharan Africa (SSA) and can rapidly progress to cirrhosis and hepatocellular carcinoma. Recent data demonstrate ongoing HBV transmission among HIV-infected adults in SSA, suggesting that complications of HIV/HBV co-infection could be prevented with HBV vaccination. Because HBV vaccine efficacy is poorly understood among HIV-infected persons in SSA, we sought to characterize the humoral response to the HBV vaccine in HIV-seropositive Ugandan adults.

Methods: We enrolled HIV-infected adults in Kampala, Uganda without serologic evidence of prior HBV infection. Three HBV vaccine doses were administered at 0, 1 and 6 months. Anti-HBs levels were measured 4 weeks after the third vaccine dose. "Response" to vaccination was defined as anti-HBs levels ≥ 10 IU/L and "high response" as ≥ 100 IU/L. Regression analysis was used to determine predictors of response.

Results: Of 251 HIV-positive adults screened, 132 (53%) had no prior HBV infection or immunity and were enrolled. Most participants were women [89 (67%)]; median (IQR) age was 32 years (27-41), and 68 (52%) had received antiretroviral therapy (ART) for > 3 months. Median (IQR) CD4 count was 426 (261-583), and 64 (94%) of the 68 receiving ART had undetectable plasma HIV RNA. Overall, 117 (92%) participants seroconverted to the vaccine (anti-HBs ≥ 10 IU/L), with 109 (86%) participants having high-level response (anti-HBs ≥ 100 IU/L). In multivariate analysis, only baseline CD4 > 200 cells/mm3 was associated with response [OR = 6.97 (1.34-34.71), p = 0.02] and high-level response [OR = 4.25 (1.15-15.69)], p = 0.03].

Conclusion: HBV vaccination was effective in eliciting a protective humoral response, particularly among those with higher CD4 counts. Half of the screened patients did not have immunity to HBV infection, suggesting a large at-risk population for HBV infection among HIV-positive adults in Uganda. Our findings support including HBV vaccination as part of routine care among HIV-positive adults.

Keywords: HIV seropositive adults; Hepatitis B vaccine; Immune response; Sub-Saharan Africa.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

FIGURE 1:
FIGURE 1:. FLOWCHART OF PARTICIPANTS
Participant selection process: A total of 251 patients were screened for inclusion in the study. Of these, 116 were excluded because of they were either immune or currently / previously infected with HBV. The remaining individuals were enrolled. The results of the laboratory tests are as summarized above. Anti-HBc = antibody to HBV core antigen; HBsAg = hepatitis B surface antigen; anti-HBs = antibody to hepatitis B surface antigen. * Died before enrollment
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References

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