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Hepatitis B vaccination in HIV-infected youth: a randomized trial of three regimens.

Author(s): Flynn PM, Cunningham CK, Rudy B, Wilson CM, Kapogiannis B, Worrell C, Bethel J, Monte D, Bojan K

Affiliation(s): Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. pat.flynn@stjude.org

Publication date & source: 2011-04, J Acquir Immune Defic Syndr., 56(4):325-32.

Publication type: Randomized Controlled Trial; Research Support, N.I.H., Extramural

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 mug HBsAg; Arm 2: Engerix B (GlaxoSmithKline, Rixensart, Belgium), 40 mug; and Arm 3: Twinrix (GlaxoSmithKline, Rixensart, Belgium), 20 mug 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/mm3 (interquartile range, 305-668); 13% were less than 200 cells/mm3. Among Engerix B, 20-mug 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 mug (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 mug, or Twinrix and higher baseline CD4+ T-cell counts were independently associated with improved vaccine response.

Page last updated: 2011-12-09

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