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1 May 2005

Volume 191, Number 9
The Journal of Infectious Diseases 2005;191:1435–1441
© 2005 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19109-0009$15.00
DOI: 10.1086/429302
MAJOR ARTICLE

Response to Hepatitis B Vaccine in HIV‐1–Positive Subjects Who Test Positive for Isolated Antibody to Hepatitis B Core Antigen: Implications for Hepatitis B Vaccine Strategies

Rajesh T. Gandhi,1

Alysse Wurcel,1

Hang Lee,1

Barbara McGovern,2

Janet Shopis,1

Meghan Geary,1

Rohini Sivamurthy,1

Paul E. Sax,3 and

Chinweike Ukomadu3

1Massachusetts General Hospital, 2Lemuel Shattuck Hospital and New England Medical Center, and 3Brigham and Women’s Hospital, Boston

Background.Whether human immunodeficiency virus type 1 (HIV‐1)–positive subjects who test positive for isolated antibody to hepatitis B core antigen (anti‐HBc) should be vaccinated with hepatitis B vaccine is not certain. Development of an anamnestic response after vaccination would suggest previous hepatitis B virus (HBV) infection, in which case vaccination is not necessary.

Methods.Sixty‐nine HIV‐1–positive subjects who tested negative for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti‐HBs) received vaccination with standard hepatitis B vaccine. Twenty‐nine subjects (42%) tested positive for anti‐HBc, and 40 (58%) tested negative for anti‐HBc. An anamnestic response was defined as an anti‐HBs titer of 10 IU/L within 4 weeks of the first vaccination.

Results.The overall anamnestic response rate was 16% and was not significantly different between subjects who tested positive for anti‐HBc (24%) and those who tested negative for anti‐HBc (10%) before vaccination ( ). Approximately 50% of subjects who tested positive for anti‐HBc also tested positive for antibody to hepatitis Be antigen (anti‐HBe). The anamnestic response rate was higher in subjects who tested positive for both anti‐HBc and anti‐HBe (43%) than in subjects who tested positive for anti‐HBc but negative for anti‐HBe (7%) ( ). After a complete series of vaccinations, HIV‐1/hepatitis C virus (HCV)–coinfected subjects were less likely to achieve high anti‐HBs titers than were subjects infected with HIV‐1 alone.

Conclusions.After hepatitis B vaccination, the anamnestic response rate in HIV‐1–positive subjects who tested positive for isolated anti‐HBc but negative for anti‐HBe was low and was comparable to that in subjects who tested negative for anti‐HBc. This finding suggests that testing for anti‐HBc alone may not be a reliable assessment of protection from HBV infection. HIV‐1/HCV coinfection may be associated with impaired responses to hepatitis B vaccine, and evaluation of strategies to improve immunogenicity of the vaccine in such individuals is warranted.

Received 7 October 2004; accepted 30 November 2004; electronically published 28 March 2005.

Reprints or correspondence: Dr. Rajesh T. Gandhi, Infectious Diseases Unit, Massachusetts General Hospital, GRJ 504, 55 Fruit St., Boston, MA 02114 ().

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  • Presented in part: 42nd annual meeting of the Infectious Diseases Society of America, Boston, 30 September–3 October 2004 (abstract 871).

    Financial support: Harvard Medical School Center for AIDS Research.

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