THE ADOLESCENT MEDICINE HIV/AIDS RESEARCH NETWORK
Serologic Response to Hepatitis B Vaccine in HIV
Infected and High-Risk HIV Uninfected Adolescents
in the REACH Cohort
CRAIG M. WILSON, M.D., JONAS H. ELLENBERG, Ph.D., MARY K. SAWYER, M.D.,
MARVIN BELZER, M.D., PEGGY A. CROWLEY-NOWICK, Ph.D., ANA PUGA, M.D.,
DONNA C. FUTTERMAN, M.D., LIGIA PERALTA, M.D., AND
THE ADOLESCENT MEDICINE HIV/AIDS RESEARCH NETWORK
Purpose: To evaluate hepatitis B (HBV) vaccine re-
sponse rates in HIV infected and high-risk HIV unin-
fected youth and examine associations with responsive-
ness in the HIV infected group.
Methods: Cohorts within the Reaching for Excellence
in Adolescent Care and Health (REACH) study popula-
tion were defined based on receipt of HBV vaccine both
retrospectively and prospectively. Sero-responsiveness
was determined by HBsAb measurements. Testing was
done for HBsAg, HBsAb, and HBcAb. For HBsAb, a
value of > 10 International Units per liter was considered
a positive response, and the data were collected as either
positive or negative from each of the reporting laborato-
ries. Covariates of responsiveness were explored in uni-
variate 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 higher rates of
response by serology compared with HIV infected sub-
jects (70% vs. 41.1%;
2
؍ .05; RR ؍ .586, 95% CI: .36 –.96).
By the time of an annual visit 43 subjects had received
three vaccinations with at least one occurring 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. Univariate and multivariate analysis in the pro-
spective HIV infected group (N ؍ 35) found an associa-
tion between elevated CD8
؉
/CD38
؉
/HLA-DR
؉
T cells
and lack of HBV vaccine responsiveness (6.7%% vs. 60%;
2
؍ .03; RR ؍ .12, 95% CI: .02–.55).
Conclusions: The poor HBV vaccine response rate in
the HIV uninfected high-risk adolescents was unex-
pected and suggests that HBV vaccination doses have not
been optimized for older adolescents. This is the first
report of decreased responsiveness in HIV infected sub-
jects being associated with elevated CD8
؉
/CD38
؉
/
HLA
؊
DR
؉
T cells and suggests that ongoing viral repli-
cation and concomitant immune system activation
decreases the ability of the immune system in HIV
infected subjects to respond to vaccination. © Society for
Adolescent Medicine, 2001
KEY WORDS
:
HIV infection
HBV vaccine
Adolescents
Onset of sexual behavior in adolescents has been
identified as a risk factor for acquisition of hepatitis
B virus (HBV) and in regions of low HBV endemicity
as in the United States, sexual activity has been
From the University of Alabama at Birmingham, Birmingham,
Alabama (C.M.W.); Westat Inc., Rockville, Maryland (J.H.E.); Emory
University, Atlanta, Georgia (M.K.S.); Children’s Hospital of Los
Angeles, Los Angeles, California (M.B.); Brigham and Women’s Hospi-
tal, Boston, Massachusetts (P.A.C.-N.); Children’s Diagnostic and
Treatment Center, Ft. Lauderdale, Florida (A.P.); Department of Pedi-
atrics, Children’s Hospital at Montefiore, Albert Einstein College of
Medicine, New York, New York (D.C.F.); and the University of
Maryland, Baltimore, Maryland (L.P.).
Address correspondence to: Craig M. Wilson, M.D., University of
Alabama at Birmingham, Geographic Medicine BBRB 206F, Birming-
ham, AL 35294-2170. E-mail: cwilson@uab.edu.
Manuscript accepted May 10, 2001.
JOURNAL OF ADOLESCENT HEALTH 2001;29S:123–129
© Society for Adolescent Medicine, 2001
Published by Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 10010
1054-139X/01/$–see front matter
PII S1054-139X(01)00278-6