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Two Doses of Hep A Vaccine in HIV+ Men Equivalent to One Dose in HIV- Men
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50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), September 12-15, 2010, Boston
Mark Mascolini
HIV-infected gay men who got two doses of the hepatitis A virus (HAV) vaccine in Taiwan had a response rate equivalent to that of HIV-negative gays who got one dose [1]. HIV-positive men who got only one vaccine shot had a much lower response rate than the other two groups.
HAV vaccination is recommended for HAV-negative gay men with HIV [2] because they have a substantially higher HAV prevalence than HIV-negative gays--30% versus 10%, according to researchers at Taipei City Hospital and National Taiwan University Hospital. They planned this study to assess two HAV vaccine schedules in HIV-positive gays and to compare response rates with HIV-negative gays.
All study participants were under 40 years old and were recruited from HIV clinics and voluntary counseling and testing services. The investigators tested all men for anti-HAV antibody IgG and offered negative men HAV vaccination. HIV-infected men were scheduled to receive either two doses (at 0 and 6 months) or three doses (at 0, 1, and 6 months). Men without HIV were put on the two-dose schedule. The researchers tested men for anti-HAV antibody at 6 months, before the last vaccine shot. HAV prevalence was 15% in men with HIV and 7% in HIV-negative men.
Of the 536 HAV-negative men who enrolled in the vaccination study, 318 had HIV and 218 did not. In the HIV group, 140 got two vaccine shots and 178 got three. (The investigators did not explain whether these men were randomized to two or three shots.) Among men whose antibody response rate was determined before the final immunization at week 24, 45 of 118 HIV-infected men (38%) who had one shot seroconverted, compared with 85 of 135 HIV-infected men (63%) who had two shots, and 97 of 171 HIV-negative men (57%) who had one shot.
Seroconversion rates were uniformly higher in HIV-infected men who had a CD4 count above 200 than in those with a count below 200. No HIV-infected man who got two vaccines shots with a CD4 count below 200 responded at 24 or 48 weeks. Among HIV-infected men who got two doses with a CD4 count above 200, almost 40% responded at week 24 and more than 70% responded by week 48. Among HIV-infected men who got three doses with a CD4 count above 200, 50% responded at week 24 and 90% at week 48. Those last response rates were equivalent to rates among HIV-negative men who got two vaccine doses.
The US Centers for Disease Control and Prevention currently recommends two HAV vaccine doses for people with HIV regardless of CD4 count [2].
References
1. Tseng Y, Liu W, Lu C, et al. Comparisons of serologic responses to hepatitis A vaccination between HIV-infected and HIV-uninfected men who have sex with men in the era of highly active antiretroviral therapy. 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). September 12-15, 2010. Boston. Abstract H-217.
2. Centers for Disease Control and Prevention. Recommended adult immunization schedule--United States, 2010. MMWR. 2010;59(1). http://www.cdc.gov/mmwr/PDF/wk/mm5901-Immunization.pdf
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