Prevention and Treatment of Hepatitis B Virus Infection in HIV-Infected Patients

We describe in a multicenter study the feasibility and effectiveness of an accelerated hepatitis B vaccination schedule compared to the standard regimen in HIV-infected patients. The results show that the compliance with an accelerated schedule is significantly better, although its efficacy is only non-inferior in patients with a CD4+ cell-count >500 cells/mm3. In all HIV-infected patients a better response rate is provided in patients on HAART with undetectable HIV-RNA load, longer duration of HAART use, female gender and younger age. Around 50% of our HIV-infected cohort responded on initial HBV vaccination. In an attempt to achieve a higher response rate we prospectively revaccinated all non-responders three times at monthly intervals with double dose HBV vaccine. An additional 51% responded in the revaccination series. This response was more likely in patients younger than 40 years of age, irrespective of viral load, while in patients older than 40 years an undetectable HIV-RNA load is associated with a better response rate. We studied the possible relationship between HBV and influenza vaccination in HIV-infected patients. A trend for higher geometric mean titers, both in pre- and post- influenza immunization was found in HBV vaccination responders. We also retrospectively investigated the long-term efficacy of tenofovir administered as a part of antiretroviral therapy in a large cohort of HIV/HBV co-infected patients. It is shown that after five years of follow-up, approximately 90% of patients achieved undetectable HBV-DNA load. There was no significant difference between patients with or without lamivudine resistance at baseline. Furthermore, no confirmed genotypic substitutions in the HBV polymerase gene associated with decreased sensitivity to tenofovir have been identified in our cohort