Factors Associated With Seroconversion After Standard Dose Hepatitis B Vaccination and High-Dose Revaccination Among HIV-Infected Patients

[Guest guest]

http://thomasland.metapress.com/content/jt0886v1h394t053/

Journal Article

Factors Associated With Seroconversion After Standard Dose Hepatitis B

Vaccination and High-Dose Revaccination Among HIV-Infected Patients

Journal HIV Clinical Trials

Publisher Land Publishers Inc.

ISSN 1528-4336

Issue Volume 11, Number 6 / Nov-Dec 2010

Category Original Article

Pages 332-339

DOI 10.1310/hct1106-332

Online Date Friday, January 14, 2011

Authors

Natasha N. Pettit1, 2, Daryl D. DePestel1, 2, Preeti N. Malani3, 4, 5,

Riddell IV3

1Department of Clinical, Social and Administrative Sciences, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

2Department of Pharmacy Services, University of Michigan College of Pharmacy,

Ann Arbor, Michigan, USA

3Department of Internal Medicine, Division of Infectious Diseases, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

4Division of Geriatric Medicine, University of Michigan Health System, Ann

Arbor, Michigan, USA

5Veterans Affairs Ann Arbor Healthcare System and Geriatric Research Education

and Clinical Center (GRECC), University of Michigan Health System, Ann Arbor,

Michigan, USA

Abstract

Background: Patients with HIV-infection often respond poorly to vaccination. We

sought to determine rates of seroconversion among HIV-infected patients

receiving the hepatitis B vaccine and for non-responders who received high-dose

revaccination.

Methods: A single-center retrospective chart review was performed. Patients

received either a series of Engerix-B (20 mcg) or Twinrix (standard dose vaccine

[sDV]). A subset of non-responders received a higher 40 mcg dose series of

Engerix-B (high-dose revaccination [HDR]).

Results: 215 patients received SDV with an overall response rate of 46.5%. Among

the 115 non-responders, 30 received HDR with an overall response rate of 66.7%.

Factors associated with response to SDV included younger age (odds ratio [OR]/1

year = 0.97, P = .03), higher CD4 at first dose (OR/100 CD4 = 1.13, P = .02),

and receipt of Twinrix versus Engerix-B (OR = 2.3, P = .003). Higher CD4 at

first dose was also associated with response to HDR (OR/100 CD4 = 2.0, P = .02).

All factors remained independently associated with response to SDV and HDR on

multivariable analysis.

Conclusions: HDR appears to be a viable strategy to achieve seroconversion among

HIV-infected patients who fail to respond to SDV. Higher CD4 at vaccination,

younger age, and receipt of Twinrix were independently associated with SDV

seroconversion.

[Guest guest]

http://thomasland.metapress.com/content/jt0886v1h394t053/

Journal Article

Factors Associated With Seroconversion After Standard Dose Hepatitis B

Vaccination and High-Dose Revaccination Among HIV-Infected Patients

Journal HIV Clinical Trials

Publisher Land Publishers Inc.

ISSN 1528-4336

Issue Volume 11, Number 6 / Nov-Dec 2010

Category Original Article

Pages 332-339

DOI 10.1310/hct1106-332

Online Date Friday, January 14, 2011

Authors

Natasha N. Pettit1, 2, Daryl D. DePestel1, 2, Preeti N. Malani3, 4, 5,

Riddell IV3

1Department of Clinical, Social and Administrative Sciences, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

2Department of Pharmacy Services, University of Michigan College of Pharmacy,

Ann Arbor, Michigan, USA

3Department of Internal Medicine, Division of Infectious Diseases, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

4Division of Geriatric Medicine, University of Michigan Health System, Ann

Arbor, Michigan, USA

5Veterans Affairs Ann Arbor Healthcare System and Geriatric Research Education

and Clinical Center (GRECC), University of Michigan Health System, Ann Arbor,

Michigan, USA

Abstract

Background: Patients with HIV-infection often respond poorly to vaccination. We

sought to determine rates of seroconversion among HIV-infected patients

receiving the hepatitis B vaccine and for non-responders who received high-dose

revaccination.

Methods: A single-center retrospective chart review was performed. Patients

received either a series of Engerix-B (20 mcg) or Twinrix (standard dose vaccine

[sDV]). A subset of non-responders received a higher 40 mcg dose series of

Engerix-B (high-dose revaccination [HDR]).

Results: 215 patients received SDV with an overall response rate of 46.5%. Among

the 115 non-responders, 30 received HDR with an overall response rate of 66.7%.

Factors associated with response to SDV included younger age (odds ratio [OR]/1

year = 0.97, P = .03), higher CD4 at first dose (OR/100 CD4 = 1.13, P = .02),

and receipt of Twinrix versus Engerix-B (OR = 2.3, P = .003). Higher CD4 at

first dose was also associated with response to HDR (OR/100 CD4 = 2.0, P = .02).

All factors remained independently associated with response to SDV and HDR on

multivariable analysis.

Conclusions: HDR appears to be a viable strategy to achieve seroconversion among

HIV-infected patients who fail to respond to SDV. Higher CD4 at vaccination,

younger age, and receipt of Twinrix were independently associated with SDV

seroconversion.

[Guest guest]

http://thomasland.metapress.com/content/jt0886v1h394t053/

Journal Article

Factors Associated With Seroconversion After Standard Dose Hepatitis B

Vaccination and High-Dose Revaccination Among HIV-Infected Patients

Journal HIV Clinical Trials

Publisher Land Publishers Inc.

ISSN 1528-4336

Issue Volume 11, Number 6 / Nov-Dec 2010

Category Original Article

Pages 332-339

DOI 10.1310/hct1106-332

Online Date Friday, January 14, 2011

Authors

Natasha N. Pettit1, 2, Daryl D. DePestel1, 2, Preeti N. Malani3, 4, 5,

Riddell IV3

1Department of Clinical, Social and Administrative Sciences, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

2Department of Pharmacy Services, University of Michigan College of Pharmacy,

Ann Arbor, Michigan, USA

3Department of Internal Medicine, Division of Infectious Diseases, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

4Division of Geriatric Medicine, University of Michigan Health System, Ann

Arbor, Michigan, USA

5Veterans Affairs Ann Arbor Healthcare System and Geriatric Research Education

and Clinical Center (GRECC), University of Michigan Health System, Ann Arbor,

Michigan, USA

Abstract

Background: Patients with HIV-infection often respond poorly to vaccination. We

sought to determine rates of seroconversion among HIV-infected patients

receiving the hepatitis B vaccine and for non-responders who received high-dose

revaccination.

Methods: A single-center retrospective chart review was performed. Patients

received either a series of Engerix-B (20 mcg) or Twinrix (standard dose vaccine

[sDV]). A subset of non-responders received a higher 40 mcg dose series of

Engerix-B (high-dose revaccination [HDR]).

Results: 215 patients received SDV with an overall response rate of 46.5%. Among

the 115 non-responders, 30 received HDR with an overall response rate of 66.7%.

Factors associated with response to SDV included younger age (odds ratio [OR]/1

year = 0.97, P = .03), higher CD4 at first dose (OR/100 CD4 = 1.13, P = .02),

and receipt of Twinrix versus Engerix-B (OR = 2.3, P = .003). Higher CD4 at

first dose was also associated with response to HDR (OR/100 CD4 = 2.0, P = .02).

All factors remained independently associated with response to SDV and HDR on

multivariable analysis.

Conclusions: HDR appears to be a viable strategy to achieve seroconversion among

HIV-infected patients who fail to respond to SDV. Higher CD4 at vaccination,

younger age, and receipt of Twinrix were independently associated with SDV

seroconversion.

[Guest guest]

http://thomasland.metapress.com/content/jt0886v1h394t053/

Journal Article

Factors Associated With Seroconversion After Standard Dose Hepatitis B

Vaccination and High-Dose Revaccination Among HIV-Infected Patients

Journal HIV Clinical Trials

Publisher Land Publishers Inc.

ISSN 1528-4336

Issue Volume 11, Number 6 / Nov-Dec 2010

Category Original Article

Pages 332-339

DOI 10.1310/hct1106-332

Online Date Friday, January 14, 2011

Authors

Natasha N. Pettit1, 2, Daryl D. DePestel1, 2, Preeti N. Malani3, 4, 5,

Riddell IV3

1Department of Clinical, Social and Administrative Sciences, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

2Department of Pharmacy Services, University of Michigan College of Pharmacy,

Ann Arbor, Michigan, USA

3Department of Internal Medicine, Division of Infectious Diseases, University of

Michigan College of Pharmacy, Ann Arbor, Michigan, USA

4Division of Geriatric Medicine, University of Michigan Health System, Ann

Arbor, Michigan, USA

5Veterans Affairs Ann Arbor Healthcare System and Geriatric Research Education

and Clinical Center (GRECC), University of Michigan Health System, Ann Arbor,

Michigan, USA

Abstract

Background: Patients with HIV-infection often respond poorly to vaccination. We

sought to determine rates of seroconversion among HIV-infected patients

receiving the hepatitis B vaccine and for non-responders who received high-dose

revaccination.

Methods: A single-center retrospective chart review was performed. Patients

received either a series of Engerix-B (20 mcg) or Twinrix (standard dose vaccine

[sDV]). A subset of non-responders received a higher 40 mcg dose series of

Engerix-B (high-dose revaccination [HDR]).

Results: 215 patients received SDV with an overall response rate of 46.5%. Among

the 115 non-responders, 30 received HDR with an overall response rate of 66.7%.

Factors associated with response to SDV included younger age (odds ratio [OR]/1

year = 0.97, P = .03), higher CD4 at first dose (OR/100 CD4 = 1.13, P = .02),

and receipt of Twinrix versus Engerix-B (OR = 2.3, P = .003). Higher CD4 at

first dose was also associated with response to HDR (OR/100 CD4 = 2.0, P = .02).

All factors remained independently associated with response to SDV and HDR on

multivariable analysis.

Conclusions: HDR appears to be a viable strategy to achieve seroconversion among

HIV-infected patients who fail to respond to SDV. Higher CD4 at vaccination,

younger age, and receipt of Twinrix were independently associated with SDV

seroconversion.