Hepatitis B prophylaxis in HIV-infected patients

SummaryThe risk of infection with hepatitis B virus is higher in HIV-infected patients due to shared risk factors. Unfortunately, the efficacy of immunisation against HBV in this group is much worse than in general population. Especially patients with low CD4 cell count and high HIV viral load present with lower rate of response. Therefore the use of double vaccine doses or prolongation of the vaccination schedule is recommended in those whose post-vaccination anti-HBs titers are less than 10 mIU/ml. It is uncertain how to manage the patients with “isolated” anti-HBc, where other serological markers of HBV infection are negative. Some recommend vaccination in these patients as well.It is advisable to measure HBV DNA in patients with “isolated” anti-HBc, as a part of them may present with occult hepatitis B.