RESPONSE TO HEPATITIS-B IMMUNIZATION BY INFANTS EXPOSED TO HIV

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.