The Timing of Hepatitis B Virus (HBV) Immunization Relative to Human Immunodeficiency Virus (HIV) Diagnosis and the Risk of HBV Infection Following HIV Diagnosis

[Guest guest]

http://aje.oxfordjournals.org/content/early/2010/11/03/aje.kwq326.abstract

The Timing of Hepatitis B Virus (HBV) Immunization Relative to Human

Immunodeficiency Virus (HIV) Diagnosis and the Risk of HBV Infection Following

HIV Diagnosis

L. Landrum*, Huppler Hullsiek, Helen M. Chun, F.

Crum-Cianflone, Anuradha Ganesan, Amy C. Weintrob, R. Barthel, J.

O'Connell and K. Agan

*Correspondence to Dr. L. Landrum, Infectious Disease Service,

Army Medical Center, 3851 Drive, MCHE-MDI, Fort Sam Houston, TX

78234 (e-mail: mlandrum@...).

Received April 21, 2010.

Accepted August 26, 2010.

Abstract

To assess associations between the timing of hepatitis B virus (HBV)

immunization relative to human immunodeficiency virus (HIV) diagnosis and

vaccine effectiveness, US Military HIV Natural History Study cohort participants

without HBV infection at the time of HIV diagnosis were grouped by vaccination

status, retrospectively followed from HIV diagnosis for incident HBV infection,

and compared using proportional hazards models. A positive vaccine response

was defined as hepatitis B surface antibody level ™10 IU/L. Of 1,877

participants enrolled between 1989 and 2008, 441 (23%) were vaccinated prior to

HIV diagnosis. Eighty percent of those who received vaccine doses only before

HIV diagnosis had a positive vaccine response, compared with 66% of those who

received doses both before and after HIV and 41% of those who received doses

only after HIV (P < 0.01 for both compared with persons vaccinated before HIV

only). Compared with the unvaccinated, persons vaccinated only before HIV had

reduced risk of HBV infection after HIV diagnosis (hazard ratio = 0.38, 95%

confidence interval: 0.20, 0.75). No reduction in HBV infection risk was

observed for other vaccination groups. These data suggest that completion of the

vaccine series prior to HIV infection may be the optimal strategy for preventing

this significant comorbid infection in HIV-infected persons.

American Journal of Epidemiology ¿ The Author 2010. Published by Oxford

University Press on behalf of the s Hopkins Bloomberg School of Public

Health. All rights reserved. For permissions, please e-mail:

journals.permissions@....

[Guest guest]

http://aje.oxfordjournals.org/content/early/2010/11/03/aje.kwq326.abstract

The Timing of Hepatitis B Virus (HBV) Immunization Relative to Human

Immunodeficiency Virus (HIV) Diagnosis and the Risk of HBV Infection Following

HIV Diagnosis

L. Landrum*, Huppler Hullsiek, Helen M. Chun, F.

Crum-Cianflone, Anuradha Ganesan, Amy C. Weintrob, R. Barthel, J.

O'Connell and K. Agan

*Correspondence to Dr. L. Landrum, Infectious Disease Service,

Army Medical Center, 3851 Drive, MCHE-MDI, Fort Sam Houston, TX

78234 (e-mail: mlandrum@...).

Received April 21, 2010.

Accepted August 26, 2010.

Abstract

To assess associations between the timing of hepatitis B virus (HBV)

immunization relative to human immunodeficiency virus (HIV) diagnosis and

vaccine effectiveness, US Military HIV Natural History Study cohort participants

without HBV infection at the time of HIV diagnosis were grouped by vaccination

status, retrospectively followed from HIV diagnosis for incident HBV infection,

and compared using proportional hazards models. A positive vaccine response

was defined as hepatitis B surface antibody level ™10 IU/L. Of 1,877

participants enrolled between 1989 and 2008, 441 (23%) were vaccinated prior to

HIV diagnosis. Eighty percent of those who received vaccine doses only before

HIV diagnosis had a positive vaccine response, compared with 66% of those who

received doses both before and after HIV and 41% of those who received doses

only after HIV (P < 0.01 for both compared with persons vaccinated before HIV

only). Compared with the unvaccinated, persons vaccinated only before HIV had

reduced risk of HBV infection after HIV diagnosis (hazard ratio = 0.38, 95%

confidence interval: 0.20, 0.75). No reduction in HBV infection risk was

observed for other vaccination groups. These data suggest that completion of the

vaccine series prior to HIV infection may be the optimal strategy for preventing

this significant comorbid infection in HIV-infected persons.

American Journal of Epidemiology ¿ The Author 2010. Published by Oxford

University Press on behalf of the s Hopkins Bloomberg School of Public

Health. All rights reserved. For permissions, please e-mail:

journals.permissions@....