HEPATITIS-A IMMUNIZATION IN HIV-INFECTED HEMOPHILIC PATIENTS

Forty-seven HIV-infected haemophilic patients were entered into a hepa titis A vaccination programme. 10 patients (21%) were IgG seropositive for hepatitis A consistent with past exposure. Of the 37 patients off ered vaccination, one refused and 31 completed the vaccination course. 17/13 (55%) seroconverted, nine after the second and eight after the third injection, and 14 patients failed to seroconvert. The CD4 lympho cyte counts immediately prior to vaccination were significantly higher in the patients who developed immunity compared to the nonresponders (median CD4 count in the immune group 380 x 10(6)/l (range 170-1290), median CD4 count in nonimmune group 110 x 10(6)/l (range 10-590), P=0. 003). No patient with a CD4 count < 170 x 10(6)/l seroconverted and fi ve patients with well-preserved CD4 counts also failed to seroconvert. We conclude that HIV-infected haemophilic patients, especially those with more advanced disease, have an impaired response to hepatitis A v accination. Due to the likely failure of response in patients with CD4 counts < 150 x 10(6)/l, it is reasonable not to include these patient s in a hepatitis A vaccination programme.