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 nonresponders 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 nonresponders received a higher 40 mcg dose series of Engerix-B (high-dose revaccination [HDIR]). Results: 215 patients received SDV with an overall response rate of 46.5%. Among the 115 nonresponders, 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.