Objective: To assess the antibody response to hepatitis B HIV-infected
and uninfected infants. Design: Cohort, comparing hepatitis B surface
-antibody responses of HIV-infected infants with HIV-exposed but uninf
ected infants. Setting: Urban children's hospital outpatient clinic fo
r families with HIV-infected members. Intervention: All infants receiv
ed hepatitis B vaccine according to the American Academy of Pediatrics
and Centers for Disease Control and Prevention recommended schedule.
Results: Forty-one HIV-exposed or infected infants were immunized with
hepatitis B vaccine in the first year of life. Twenty-two out of 24 (
92%) HIV-exposed but uninfected infants demonstrated an antibody respo
nse to hepatitis B immunization, compared with six out of 17 (35%) HIV
-infected infants (P < 0.0005). CD4 percentage and CD4 counts were sig
nificantly lower in the HIV-infected infants than in the uninfected in
fants, but there was no significant difference in CD4 count or percent
age between HIV- infected responders and nonresponders. Conclusion: Th
e humoral immune response to hepatitis B immunization, administered be
fore 12 months of age, is significantly reduced in HIV-infected childr
en and is independent of CD4 count. Given the large number of infants
born each year to pregnant women coinfected with HIV and hepatitis B,
further studies to assess the efficacy of increased doses of antigen a
nd variations in the dosage schedule are urgently needed.