Abstract
IMPORTANCE:Data on long-term immune responses to hepatitis B virus (HBV) vaccination in adults with human immunodeficiency virus 1 (HIV-1) infection are scarce.OBJECTIVE:To compare long-term (up to month 42) immune responses to the standard HBV vaccination regimen with a 4-injection intramuscular double-dose regimen and a 4-injection intradermal low-dose regimen.DESIGN, SETTING, AND PARTICIPANTS:The phase 3, open-label, multicenter parallel-group (1:1:1 allocation ratio) randomized clinical trial was conducted from June 28, 2007, to October 23, 2008, at 33 centers in France. Participants included 437 HBV-seronegative adults with HIV-1 and CD4 cell counts of more than 200/μL. Follow-up was extended to September 12, 2012, and data were assessed from February 13, 2015, to January 22, 2016. The analysis was imputed for an intention-to-treat population.INTERVENTIONS:Patients were randomly assigned to receive 3 intramuscular standard-dose (20-μg) injections of recombinant HBV vaccine at weeks 0, 4, and 24 (IM20 × 3 group) (145 participants), 4 intramuscular double-dose (40-μg) injections at weeks 0, 4, 8, and 24 (IM40 × 4 group) (148 participants), or 4 intradermal low-dose (4-μg) injections at weeks 0, 4, 8, and 24 (ID4 × 4 group) (144 participants).MAIN OUTCOMES AND MEASURES:The previously published primary trial end point was the percentage of responders at week 28, defined as patients with hepatitis B surface antibody (HBsAb) levels of at least 10 mIU/mL among patients who received at least 1 vaccine dose. The secondary trial end points included the percentage of responders at months 18, 30, and 42 and the duration of response from week 28. Multiple imputation was used to address missing measurements during the follow-up.RESULTS:Among the 437 patients randomized, 426 received at least 1 dose of vaccine. Of these, 287 were men (67.4%) and they had a mean (SD) age of 42.9 (9.7) years. The percentage of responders at month 42 was 41% (95% CI, 33%-49%) in the IM20 × 3 group, 71% (95% CI, 64%-79%) in the IM40 × 4 group (P < .001 vs the IM20 × 3 group), and 44% (95% CI, 35%-53%) in the ID4 × 4 group (P = .64 vs IM20 × 3 group). Fifteen percent of the patients had HBsAb titers of less than 10 mIU/mL at 33.1 months in the IM40 × 4 group, 8.7 months in the IM20 × 3 group, and 6.8 months in the ID4 × 4 group.CONCLUSIONS AND RELEVANCE:In this follow-up of a trial of adults with HIV-1 infection, the IM40 × 4 regimen of recombinant HBV vaccine improved long-term immune response compared with the standard regimen.TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT00480792.