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.
Patients were selected from a Southern Spanish multicentric cohort of HIV-infected subjects.
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.
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.
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.
aUnit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain;
bInstituto de Biomedicina de Sevilla/Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain;
cUnidad de Enfermedades Infecciosas, Hospital Regional de Málaga, Málaga, Spain;
dMedicina Interna. Hospital Universitario San Cecilio, Granada, Spain; and
eUnidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Universidad de Córdoba, Córdoba, Spain.
Correspondence to: Karin Neukam, PharmD, PhD, Unit of Infectious Diseases, Microbiology and Preventive Medicine, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Avda Manuel Siurot s/n, Seville 41013, Spain (e-mail: firstname.lastname@example.org).
Supported by the Plan Nacional R+D+I and Red de Investigación en SIDA RD16/0025/0020-ISCIII-FEDER. K.N. and A.R.-J. are the recipients of a Miguel Servet research grant (CPII18/00033 and CP18/00111) from the Instituto de Salud Carlos III.
The authors have no funding or conflicts of interest to disclose.
Received October 23, 2018
Accepted January 03, 2019