Table 1. Summary of guidelines for HBV vaccination in adults with HIV.
| US 200910 (NIH/CDC/HIVMA*) | European 201112,13 (EACS†) | British 200814 (BHIVA‡) | |
|---|---|---|---|
| Test all for evidence of HBV infection and immunity and vaccinate if indicated |
Yes | Yes | Yes |
| Isolated hepatitis B core antibody (anti-HBc) |
Vaccinate with primary series | Give one vaccine dose and check anti-HBs 2-4 weeks later; if anti-HBs <10 IU/L, consider a full course of vaccination |
Management is controversial; could give one vaccine dose and check anti-HBs 2 weeks later; if anti-HBs <10 IU/L, then give two additional doses |
| CD4 cell count at time of vaccine initiation |
Do not delay until target CD4 count is reached, but it is best to vaccinate when CD4 cell count ≥350 cells per μL |
Offer vaccination irrespective of CD4 cell count; however, HAART should be started before vaccination for individuals with CD4 cell count ≤200 cells per μL and ongoing HIV viral replication |
No recommendation |
| When to check anti-HBs after completing vaccination series |
1 month | .. | 6-8 weeks; vaccine recipients with anti-HBs >10 but <100 IU/L should be offered one additional vaccine dose |
| What to do for non-responders (those with anti-HBs ≤10 IU/L after completion of vaccine series) |
Consider revaccination; “Certain specialists might delay revaccination until after a sustained increase in CD4 count is achieved on ART” |
Consider revaccination | Revaccinate with three high doses (40 μg) given at monthly intervals; depending of level of risk, can delay revaccination until CD4 cell count >500 cells per μL |
| Recommendation for high dose (40 μg HBsAg) |
No definite recommendation; for vaccine non-responders “certain specialists recommend…revaccination with 40 μg doses” |
No definite recommendation; “Consider double dose (40 μg) and intradermal vaccination in non-responders, in particular with low CD4 and high viremia” |
Give high dose for non-responders to vaccine series |
| Recommendation for periodic testing of anti-HBs in people who complete the vaccine series |
No recommendation; “Certain specialists suggest once yearly assessments for patients who have an ongoing risk for HBV acquisition, as recommended for dialysis patients” |
No recommendation | Measure anti-HBs yearly; offer a booster to people with anti-HBs <10 IU/L and ideally <100 IU/L |
HBV=hepatitis B virus. NIH=National Institutes of Health. CDC=Centers for Disease Control and Prevention. HIVMA=HIV Medical Association. EACS=European AIDS Clinical Society. BHIVA=British HIV Association. HAART=highly active antiretroviral therapy. ART=antiretroviral therapy.
*
US Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents released by the NIH, CDC, and HIVMA.
†
EACS Guidelines.
‡
BHIVA Guidelines for Immunisation of HIV-infected Adults.