Key result
Two hepatitis A vaccine doses show no seroconversion benefit over a single dose in HIV.
Why the study?
Recent outbreaks of hepatitis A virus have been described in men who have sex with men despite an effective vaccine, prompting evaluation of seroconversion rates after hepatitis A vaccination in HIV-infected patients under real-life conditions.
Does 1 single dose of Hepatitis A virus vaccine achieve similar seroconversion rates compared to 2 doses in HIV-infected patients?
Cohort (n=522)
Yes
Does 1 single dose of Hepatitis A virus vaccine achieve similar seroconversion rates compared to 2 doses in HIV-infected patients?
Absolute Event Rate: 88.3% vs 83.2%
p-value: p=0.107
A single dose of Hepatitis A vaccine achieves a high rate of seroconversion in HIV-infected patients with favorable response factors, which may be sufficient during vaccine shortages.
Single-dose HAV vaccination may suffice in select HIV patients during shortages; leaves open need for randomized confirmation.
BACKGROUND: Various recent outbreaks of hepatitis A virus (HAV) have been described in men who have sex with men despite the availability of an effective vaccine. This study aimed to determine the current rates of seroconversion after receiving HAV vaccine (HAV-V) in HIV-infected patients under real-life conditions. SETTING: Patients were selected from a Southern Spanish multicentric cohort of HIV-infected subjects. METHODS: Retrospective analysis of all patients who received 2 doses (standard scheme) from April 2008 to May 2016 or from June 2016 to February 2018 facing an HAV outbreak with shortage of HAV-V, 1 single dose of HAV-V. Response to HAV-V was defined as positive anti-HAV IgG between 1 and 12 months after the last vaccination dose. RESULTS: A total of 522 patients were included, mainly men who have sex with men (86.2%). In the standard-dose group, 303/343 [88.3%; 95% confidence interval (CI): 84.5 to 91.5] patients showed seroconversion as compared with 149/179 (83.2%; 95% CI: 76.9 to 88.4) of the single-dose group (P = 0.107). Undetectable baseline HIV-RNA (adjusted odds ratio: 4.86; 95% CI: 1.86 to 12.75; P = 0.001) and a CD4 T-cell count ≥350/μL (adjusted odds ratio, 3.96; 95% CI: 1.26 to 12.49; P = 0.019) were independently associated with response to both regimens. A higher CD4/CD8 ratio was also associated with response after a single dose. CONCLUSIONS: HIV-infected patients should be encouraged to undergo HAV-V with 2 standard doses 6 months apart; a single dose achieves a high rate of seroconversion in those patients with favorable response factors and may be enough to limit future outbreaks in case of HAV-V shortage until supply is reestablished.
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Neukam et al. (2019) conducted a cohort in HIV infection (n=522). Hepatitis A virus vaccine (2 doses) vs. 1 single dose of Hepatitis A virus vaccine was evaluated on Seroconversion (positive anti-HAV IgG between 1 and 12 months after the last vaccination dose) (p=0.107). Two standard doses of hepatitis A vaccine achieved an 88.3% seroconversion rate in HIV-infected patients, compared to 83.2% with a single dose (P=0.107).
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