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Long-term Immunogenicity of a Plasma-Derived Hepatitis B Vaccine in HIV Seropositive and HIV Seronegative Hemophiliacs

Long-term Immunogenicity of a Plasma-Derived Hepatitis B Vaccine in HIV Seropositive and HIV... Abstract • Short-term studies indicate that hepatitis B vaccines are safe and satisfactorily immunogenic in hemophiliacs. The duration of immunity in these immunocompromised patients, however, is not known. To determine this, we studied 78 hemophiliacs prospectively 2, 3, and 4 years after the initial vaccination with a plasma-derived vaccine given as three monthly injections followed by a fourth booster injection at month 14. The duration of immunity clearly depended on whether the patients were infected with the human immunodeficiency virus (HIV). In HIV seronegative hemophiliacs (n = 67), there was a progressive decline in titers of antibody to the hepatitis B surface antigen (anti-HBs), but antibody was still detectable 4 years later in all of them. From the curves of decline of antibody titers, it appears that there is no need to revaccinate patients for at least 5 to 6 years. The HIV seropositive hemophiliacs (n=11) not only started from much lower anti-HBs titers, but 5 of 11 lost anti-HBs. None of the 45 patients treated with concentrates during the postvaccination period developed serologic signs of hepatitis B, even though 6 of them had come into contact with live or inactivated hepatitis B virus as shown by the occurrence of spontaneous anamnestic antibody responses. This vaccine and schedule of vaccination afford a prolonged duration of immunity in HIV seronegative hemophiliacs, but HIV seropositive hemophiliacs have a risk of losing immunity early. (Arch Intern Med. 1989;149:1333-1337) References 1. Morfini M, Rafanelli D, Longo G, Messori A, Rossi Ferrini PL. Hepatitis-free interval after clotting factor therapy in first infused hemophiliacs . Thromb Haemost . 1986;56:268-270. 2. Mannucci PM, Zanetti AR, Colombo M, and the Study Group of the Fondazione dell'Emofilia. Prospective study of hepatitis after factor VIII concentrate exposed to hot vapor . Br J Haematol . 1988;68:427-430.Crossref 3. Gazangel C, Courouce AM, Torchet MF, et al. Use of HBV vaccine in hemophiliacs . Scand J Haematol Suppl . 1984;33( (suppl 40) ):323-325.Crossref 4. Hedner U, Hansson BG, Vermylen J, et al. Immunization of hemophiliacs against hepatitis B . Scand J Haematol Suppl . 1984;33( (suppl 40) ):317-321.Crossref 5. Janco RL. Immunogenicity of subcutaneous hepatitis B vaccine in hemophiliacs . J Pediatr . 1985;107:316.Crossref 6. Zanetti AR, Mannucci PM, Tanzi E, et al. Hepatitis B vaccination of 113 hemophiliacs: lower antibody response in anti-LAV-HTLA-III-positive patients . Am J Hematol . 1986;23:339-345.Crossref 7. Drake JH, Parmley RT, Britton HA. Loss of hepatitis B antibody in human immunodeficiency virus-positive hemophilia patients . Pediatr Infect Dis J . 1978;6:1051-1054.Crossref 8. Ragni MV, Spero JA, Lewis JH. Relation of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection in hemophiliacs . Blood . 1987;70( (suppl 1) ):126a. 9. Hollinger FB, Adam E, Heiberg D, Melinick JL. Response to hepatitis B vaccine in a young adult population . In: Smunzness W, Alter HS, Mayrard JE, eds. Viral Hepatitis . New York, NY: Grune & Stratton; 1984:275. 10. Wallenstein S, Zucker CL, Fleiss JL. Some statistical methods useful in circulation research . Circ Res . 1980;47:1-9.Crossref 11. Perrillo RP, Regenstein FG, Roodman ST. Chronic hepatitis B in asymptomatic homosexual men with antibody to human immunodeficiency virus . Ann Intern Med . 1986;105:382-383.Crossref 12. Hadler SC, Judson F, Echenberg D, et al. Effect of prior human immunodeficiency virus infection on the outcome of hepatitis B virus infection . J Med Virol . 1987;21( (A) ):87A. 13. Hadler SC. Hepatitis B prevention and human immunodeficiency virus (HIV) infection . Ann Intern Med . 1988;109:92-94.Crossref 14. Hadler SC. Are booster doses of hepatitis B vaccine necessary? Ann Intern Med . 1988;108:457-458.Crossref 15. Horowitz MR, Ershler WB, McKinney WP, Battiola J. Duration of immunity after hepatitis B vaccination: efficacy of low dose booster vaccine . Ann Intern Med . 1988;108:185-189.Crossref 16. Hadler SC, Francis DP, Maynard JE, et al. Long term immunogenicity and efficacy of hepatitis B vaccine in homosexual men . N Engl J Med . 1986; 315:209-214.Crossref 17. Centers for Disease Control. Update on hepatitis B prevention: recommendations of the Immunization Practices Advisory Committee . Ann Intern Med . 1987;107:353-357.Crossref 18. Collier AC, Corey L, Murphy VL, Handfield HH. Antibody to human immunodeficiency virus (HIV) and suboptimal response to hepatitis B vaccination . Ann Intern Med . 1988;109:101-105.Crossref 19. Carne CA, Weller IVD, Waite J, Briggs M, Pearce F, Adler MW. Impaired responsiveness of homosexual men with HIV antibodies to plasma derived hepatitis B vaccines . Br Med J . 1987;294:866-868.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Long-term Immunogenicity of a Plasma-Derived Hepatitis B Vaccine in HIV Seropositive and HIV Seronegative Hemophiliacs

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1989.00390060067014
Publisher site
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Abstract

Abstract • Short-term studies indicate that hepatitis B vaccines are safe and satisfactorily immunogenic in hemophiliacs. The duration of immunity in these immunocompromised patients, however, is not known. To determine this, we studied 78 hemophiliacs prospectively 2, 3, and 4 years after the initial vaccination with a plasma-derived vaccine given as three monthly injections followed by a fourth booster injection at month 14. The duration of immunity clearly depended on whether the patients were infected with the human immunodeficiency virus (HIV). In HIV seronegative hemophiliacs (n = 67), there was a progressive decline in titers of antibody to the hepatitis B surface antigen (anti-HBs), but antibody was still detectable 4 years later in all of them. From the curves of decline of antibody titers, it appears that there is no need to revaccinate patients for at least 5 to 6 years. The HIV seropositive hemophiliacs (n=11) not only started from much lower anti-HBs titers, but 5 of 11 lost anti-HBs. None of the 45 patients treated with concentrates during the postvaccination period developed serologic signs of hepatitis B, even though 6 of them had come into contact with live or inactivated hepatitis B virus as shown by the occurrence of spontaneous anamnestic antibody responses. This vaccine and schedule of vaccination afford a prolonged duration of immunity in HIV seronegative hemophiliacs, but HIV seropositive hemophiliacs have a risk of losing immunity early. (Arch Intern Med. 1989;149:1333-1337) References 1. Morfini M, Rafanelli D, Longo G, Messori A, Rossi Ferrini PL. Hepatitis-free interval after clotting factor therapy in first infused hemophiliacs . Thromb Haemost . 1986;56:268-270. 2. Mannucci PM, Zanetti AR, Colombo M, and the Study Group of the Fondazione dell'Emofilia. Prospective study of hepatitis after factor VIII concentrate exposed to hot vapor . Br J Haematol . 1988;68:427-430.Crossref 3. Gazangel C, Courouce AM, Torchet MF, et al. Use of HBV vaccine in hemophiliacs . Scand J Haematol Suppl . 1984;33( (suppl 40) ):323-325.Crossref 4. Hedner U, Hansson BG, Vermylen J, et al. Immunization of hemophiliacs against hepatitis B . Scand J Haematol Suppl . 1984;33( (suppl 40) ):317-321.Crossref 5. Janco RL. Immunogenicity of subcutaneous hepatitis B vaccine in hemophiliacs . J Pediatr . 1985;107:316.Crossref 6. Zanetti AR, Mannucci PM, Tanzi E, et al. Hepatitis B vaccination of 113 hemophiliacs: lower antibody response in anti-LAV-HTLA-III-positive patients . Am J Hematol . 1986;23:339-345.Crossref 7. Drake JH, Parmley RT, Britton HA. Loss of hepatitis B antibody in human immunodeficiency virus-positive hemophilia patients . Pediatr Infect Dis J . 1978;6:1051-1054.Crossref 8. Ragni MV, Spero JA, Lewis JH. Relation of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection in hemophiliacs . Blood . 1987;70( (suppl 1) ):126a. 9. Hollinger FB, Adam E, Heiberg D, Melinick JL. Response to hepatitis B vaccine in a young adult population . In: Smunzness W, Alter HS, Mayrard JE, eds. Viral Hepatitis . New York, NY: Grune & Stratton; 1984:275. 10. Wallenstein S, Zucker CL, Fleiss JL. Some statistical methods useful in circulation research . Circ Res . 1980;47:1-9.Crossref 11. Perrillo RP, Regenstein FG, Roodman ST. Chronic hepatitis B in asymptomatic homosexual men with antibody to human immunodeficiency virus . Ann Intern Med . 1986;105:382-383.Crossref 12. Hadler SC, Judson F, Echenberg D, et al. Effect of prior human immunodeficiency virus infection on the outcome of hepatitis B virus infection . J Med Virol . 1987;21( (A) ):87A. 13. Hadler SC. Hepatitis B prevention and human immunodeficiency virus (HIV) infection . Ann Intern Med . 1988;109:92-94.Crossref 14. Hadler SC. Are booster doses of hepatitis B vaccine necessary? Ann Intern Med . 1988;108:457-458.Crossref 15. Horowitz MR, Ershler WB, McKinney WP, Battiola J. Duration of immunity after hepatitis B vaccination: efficacy of low dose booster vaccine . Ann Intern Med . 1988;108:185-189.Crossref 16. Hadler SC, Francis DP, Maynard JE, et al. Long term immunogenicity and efficacy of hepatitis B vaccine in homosexual men . N Engl J Med . 1986; 315:209-214.Crossref 17. Centers for Disease Control. Update on hepatitis B prevention: recommendations of the Immunization Practices Advisory Committee . Ann Intern Med . 1987;107:353-357.Crossref 18. Collier AC, Corey L, Murphy VL, Handfield HH. Antibody to human immunodeficiency virus (HIV) and suboptimal response to hepatitis B vaccination . Ann Intern Med . 1988;109:101-105.Crossref 19. Carne CA, Weller IVD, Waite J, Briggs M, Pearce F, Adler MW. Impaired responsiveness of homosexual men with HIV antibodies to plasma derived hepatitis B vaccines . Br Med J . 1987;294:866-868.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Jun 1, 1989

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