Hepatitis B Vaccination in HIV-Infected Youth: A Randomized Trial of Three Regimens

被引:41
|
作者
Flynn, Patricia M. [1 ,2 ,3 ]
Cunningham, Coleen K. [4 ]
Rudy, Bret [5 ]
Wilson, Craig M. [6 ]
Kapogiannis, Bill [7 ]
Worrell, Carol [7 ]
Bethel, James [8 ]
Monte, Dina [8 ]
Bojan, Kelly [9 ]
机构
[1] St Jude Childrens Res Hosp, Dept Infect Dis, Memphis, TN 38105 USA
[2] Univ Tennessee, Hlth Sci Ctr, Dept Pediat, Memphis, TN USA
[3] Univ Tennessee, Hlth Sci Ctr, Dept Prevent Med, Memphis, TN USA
[4] Duke Univ, Dept Pediat, Sch Med, Durham, NC 27706 USA
[5] NYU, Dept Pediat, Sch Med, New York, NY 10016 USA
[6] Univ Alabama Birmingham, Dept Epidemiol, Birmingham, AL USA
[7] Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pediat Adolescent & Maternal AIDS Branch, NIH, Rockville, MD USA
[8] Westat Corp, Rockville, MD USA
[9] Core Ctr, Adolescent Div, Chicago, IL USA
基金
美国国家卫生研究院;
关键词
HIV; hepatitis B vaccination; adolescents; Engerix B; Twinrix; IMPAIRED RESPONSE; SEROLOGIC RESPONSE; ANTIBODY-RESPONSE; HOMOSEXUAL MEN; A VACCINE; CHILDREN; IMMUNIZATION; EFFICACY; INFANTS; IMMUNOGENICITY;
D O I
10.1097/QAI.0b013e318203e9f2
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: HIV-infected youth are at risk of hepatitis B infection and should be vaccinated. Previous reports suggest reduced response to standard hepatitis B vaccine regimens. Methods: HIV-infected youth, aged 12 to younger than 25 years, were randomly assigned to one of three treatment arms: Arm 1: Engerix B, 20 mg HBsAg; Arm 2: Engerix B (GlaxoSmithKline, Rixensart, Belgium), 40 mg; and Arm 3: Twinrix (GlaxoSmithKline, Rixensart, Belgium), 20 mg HBsAg combined with 720 ELU hepatitis A antigen. Vaccines were administered at Weeks 0, 4, and 24. Results: Characteristics of evaluable patients (n = 336) at entry were similar in the study arms. At enrollment, median CD4(+) T-cell count was 460 cells/mm(3) (interquartile range, 305-668); 13% were less than 200 cells/mm(3). Among Engerix B, 20-mg recipients, 60.4% responded to vaccine (HBsAb 10 IU/mL or greater at Week 28). Improved vaccine response was seen in recipients of Engerix B, 40 mg (73.2% versus Arm 1, P = 0.04) and Twinrix (75.4% versus Arm 1, P = 0.02). In multivariate analysis, only baseline CD4(+) T-cell count and study arm were independent predictors of vaccine response. Conclusions: In HIV-infected youth, a three-dose vaccination regimen with Engerix B, 40 mg, or Twinrix and higher baseline CD4(+) T-cell counts were independently associated with improved vaccine response.
引用
收藏
页码:325 / 332
页数:8
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