Brief Report: Hepatitis B Vaccination Histories in Persons With HIV Needing Revaccination

Past studies of hepatitis B vaccines in people with HIV (PWH) have shown mixed results about improving responses with increases in dose or dose frequency, leading to inconsistent guidelines and practice. We examined vaccine series completion and revaccinations in PWH lacking a seroprotective response.

Hepatitis B vaccination histories were evaluated as a retrospective study in 561 participants of A5379 trial (NCT04193189). Individuals in 41 sites in Africa, Asia, South America, and the United States qualified for the trial with antibody titers below the seroprotective level (<10 mIU/mL) despite past hepatitis B vaccinations. The primary measure of interest was the number of vaccines in the past vaccination records.

Of the 1098 trial candidates, 561 (51%) did not have seroprotective titers at the time of screening and enrolled in A5379. Median age at the time of screening was 46 years (18-70 years), which varied across the regions: the lowest in Africa and the highest in the United States. The number of past hepatitis B vaccines varied widely across and within geographic regions. Twenty-four percent of the participants received ≥4 doses, up to 12, yet did not have seroprotective antibody titers.

Regardless of past vaccine records, antibody titers should be checked in PWH for revaccination needs. The recently approved long-acting and injectable antiretroviral treatment (ART) lacks protective effect against HBV, unlike tenofovir-based ART. As the long-acting ART becomes more widely used, we recommend reassessing serologies and offering the recommended CpG-adjuvanted vaccine series with promising response durability to individuals without seroprotection.