Immune response to hepatitis B vaccination in HIV-positive adults with isolated antibodies to HBV core antigen

SummaryObjectiveTo investigate the merits of vaccination against hepatitis B virus (HBV) in HIV-positive individuals with isolated antibodies to hepatitis B core antigen (anti-HBc).MethodsHIV-positive patients with isolated anti-HBc and CD4 counts >200 cells/mm3 received HBV vaccination. An antibody titre to hepatitis B surface antigen (anti-HBs titres) ≥10 IU/L one month post-vaccination was termed an anamnestic response; a titre <10 IU/L was termed a primary response. Patients with primary responses received a 3-dose vaccine course. Anti-HBs titres in all responders were measured 12 and 24 months post-vaccination.Results37 patients were studied: 19 (51%) were co-infected with hepatitis C; median CD4 count was 443 cells/mm3. 8/37 patients (22%) elicited an anamnestic response. 29/37 patients (78%) elicited a primary response. After a 3-dose vaccine course, 15/25 primary responders (60%) achieved anti-HBs titres ≥10 IU/L. HIV acquisition through injecting drug use was the only independent predictor of an anamnestic response (OR 22.9, CI 1.71–306.74, P = 0.018). Median anti-HBs titres for anamnestic and primary responders were 51 IU/L (13–127) and 157 IU/L (25–650) respectively. Of all responders, 12/23 (52%) retained anti-HBs titres ≥10 IU/L at 24 months. Anti-HBs duration was not significantly different between anamnestic and primary responders.Conclusions23/37 HIV-positive patients (62%) with isolated anti-HBc achieved anti-HBs titres ≥10 IU/L after 1–3 vaccine doses. However, duration of this immune response was short-lived (