Abstract
Background: Hepatitis B virus (HBV) infection, a leading cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma worldwide is preventable by vaccination. Completion of recommended vaccination over 90% of adults develops protective anti-Hbs antibodies levels. However, there’s paucity of data on sustained immune response to HBV vaccine among HIV infected African adults. A retrospective study was conducted and analysed 336 archived serum samples collected 3-years post HBV vaccination from participants enrolled in the Partners PrEP study, for Hepatitis B surface antibody (anti-Hbs) using ELISA.Samples that didn’t have protective anti-Hbs titers were further tested for Hepatitis B surface antigen (HBsAg). Univariate logistic regression was used to determine factors associated with non-response. Of the 336 samples tested, 176 (52.4%) were from HIV-1 infected, 40 (22.7%) were male. 160 samples from HIV-1 uninfected, 125 (78.1%) were male. The mean (standard deviation) age of the study population was 34.6 (8.5) years. Of the 62 (18%) who didn’t have protective anti-Hbs titers, 50 (81%) were HIV-1 infected. HIV infected were more likely to have less protective anti-Hbs titers (p<0.001) compared to HIV uninfected. Compared to men, women were more likely not to have protective anti-Hbs levels (11.5% vs. 25.1%, p=0.002). Seven (11.3%) of the 62 samples that didn’t have protective anti-Hbs titres, also tested positive for HBsAg, all were HIV-1 infected. More than a quarter of HIV infected vaccinated against HBV didn’t have protective anti-Hbs titres, some acquired HBV infection. Regular testing for immune response to HBV vaccination among HIV infected should be considered.
Keywords: Hepatitis B Virus, Vaccine, HIV-1 infection, Kenya
References
- Sun H-Y, Sheng W-H, Tsai M-S, Lee K-Y, Chang S-Y, Hung C-C (2014). Hepatitis B virus coinfection in human immunodeficiency virus-infected patients: A review. World J Gastroenterol. 2014;20(40): 14598-614.
- Toukan,A.U, Z.KSharaiha,O.A Hadler, H.S Margolis et.,al (19), The epidemiology of Hepatitis B virus among family members in the middle east. Am J Epidemiol 190; 132-220-32.
- Kourtis, Bulterys, Hu, Jamieson (2012). HIV-HBV coinfection--a global challenge. N Engl J Med. 2012;366:1749-52.
- Whitaker JA, Rouphael NG, Edupuganti S, Lai L, Mulligan MJ (2012). Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1. Lancet Infect Dis. 2012;12(12):966–76.
- Irungu E, Mugo N, Ngure K, Njuguna R, Celum C, Farquhar C, et al (2012). Immune Response to Hepatitis B VirusVaccination among HIV-1 Infected and Uninfected Adults in Kenya. Infect Diseas. 2012;207.
- Hepatitis B 2014. Available from: http//www.who.int/mediacentre/factsheets/fs204/en/.
- Uneke, Ogbu, Inyama, Anyanwu, Njoku, Idoko (2005). Prevalence of hepatitis-B surface antigen among blood donors and human immunodeficiency virus-infected patients in Jos,Nigeria. Mem Inst Oswaldo Cruz. 2005;100(1):13–6.
- Thio (2002). Hepatitis B and human immunodeficiency virus coinfection. Hepatology 2009;49:138-45.
- Bailey, Smith, Sands (2008). Hepatitis B vaccine: a seven-year study of adherence to the immunization guidelines and efficacy in HIV-1-positive adults. International Journal of Infectious Diseases. 2008;12(6):77–83.
- EACS European guidelines -v6.0 (2012). Treatment of HIV-positive adults in Europe 2012
- Geretti, Brook, Cameron, al. e (2008). British HIV Association guidelines for immunization of HIV-infected adults 2008. HIV Med. 2008;9:795–848.
- Tedaldi, Baker, Moorman (2004). Hepatitis A and B vaccination practices for ambulatory patients infected with HIV. Clin Infect Dis. 2004;38:1478–84.
- Assad, Francis (1999). Over a decade of experience with a yeast recombinant hepatitis B vaccine. Vaccine. 1999;18:57–67.
- Kim, Harrington, Rompaey V, Kitahata (2008). Independent clinical predictors of impaired response to hepatitis B vaccination in HIV-infected persons. STD AIDS. 2008;19(9).
- Mujugira A, Baeten J, Donnell D, al. e.(2011). Characteristics of HIV-1 serodiscordant couples enrolled in a clinical trial of antiretroviral preexposure prophylaxis for HIV-1 prevention. PLoS One. 2011;6.
- Matthews P, Beloukas A, Malik A, Carlson JM, Jooste P, Ogwu A, et al.(2015). Prevalence and Characteristics of Hepatitis B Virus (HBV) Coinfection among HIV-Positive Women in South Africa and Botswana. PLoS ONE 2015;10(7).
- Psevdos G, Kim JH, Groce V, Sharp V.(2010). Efficacy of double-dose hepatitis B rescue vaccination in HIV-infected patients. AIDS Patient Care STDS 2010; 24:403–7
Corresponding Author
Rose Wanjiku Kamoni
Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology, Kenya. P. O BOX 62000-00200, City square, Nairobi, Kenya. School of Medicine, University of Nairobi, P. O BOX 30197, GPO, Nairobi, Kenya