Serologic response to hepatitis B vaccine in HIV infected and high-risk HIV uninfected adolescents in the REACH cohort

Purpose: To evaluate hepatitis B (HBV) vaccine response rates in HIV infect ed and high-risk HIV uninfected youth and examine associations with respons iveness in the HIV infected group. Methods: Cohorts within the Reaching for Excellence in Adolescent Care and Health (REACH) study population were defined based on receipt of HBV vaccin e both retrospectively and prospectively. Sero-responsiveness was determine d by HBsAb measurements. Testing was done for HBsAg, HBsAb, and HBcAb. For HBsAb, a value of > 10 International Units per liter was considered a posit ive response, and the data were collected as either positive or negative fr om each of the reporting laboratories. Covariates of responsiveness were ex plored in univariate and multivariate models for each cohort. Results: Sixty-one subjects had received a three-dose vaccination course at the time of entry into REACH. HIV uninfected subjects had significantly hi gher rates of response by serology compared with HIV infected subjects (70% vs. 41.1%; chi (2) = .05; RR = .586, 95% CI:.36-.96). By the time of an an nual visit 43 subjects had received three vaccinations with at least one oc curring in the study period. The rates of response were similar for the HIV infected and uninfected groups (37.1% vs. 37.5%) in this cohort. Univariat e and multivariate analysis in the prospective HIV infected group (N = 35) found an association between elevated CD8(+)/CD38(+)/HLA-DR+ T cells and la ck of HBV vaccine responsiveness (6.7%% vs. 60%; chi (2) = .03; RR = .12, 9 5% CI:.02-.55). Conclusions: The poor HBV vaccine response rate in the HIV uninfected high- risk adolescents was unexpected and suggests that HBV vaccination doses hav e not been optimized for older adolescents. This is the first report of dec reased responsiveness in HIV infected subjects being associated with elevat ed CD8(+)/CD38(+)/HLA-DR+ T cells and suggests that ongoing viral replicati on and concomitant immune system activation decreases the ability of the im mune system in HIV infected subjects to respond to vaccination. (C) Society for Adolescent Medicine, 2001.