Factors associated with seroconversion after standard dose hepatitis B vaccination and high-dose revaccination among HIV-infected patients

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.