Immune Response to Double Dose Hepatitis-B Vaccine using Four Dose Schedule in HIV Infected Children

Objective To assess the immune response to hepatitis B vaccination in HIV infected children using 4 double dose schedule administered at 0-1-2-6 mo. Methods In a prospective observational study, 40 HIV infected children were vaccinated with hepatitis B virus ( HBV) vaccine ( 20 mcg, 1 ml IM at anterolateral aspect of thigh of recombinant DNA vaccine) at 0-1-2-6 mo. Anti-HBsAb titre were assessed 4-8 wk after the last dose. Clinical severity was assessed according to WHO staging. Immune status of the patients was assessed using CD 4+ counts before the vaccination. Results Of the total 40 patients, 33 ( 28 boys, 5 girls) completed the study. Six patients were in pre-antiretroviral therapy ( ART) care while 27 were receiving ART for a mean duration of 2.06 y. Ten patients belonged to WHO clinical stage 1, and 17, 2 and 4 patients to WHO clinical stage 2, 3 and 4 respectively. Median CD4+ cell count was 738/mm(3) and 28 patients had mild or no immunosuppression. Out of the total 33 patients who completed followup, only 2 patients ( 6 %) did not seroconvert ( Anti HBsAb titre at end of study <10 IU/L), the rest ( 94 %) achieved different levels of Anti HBsAb titre at end of study. Twenty two ( 66 %) patients had anti HBsAb titre more than 1000 IU/L, 8 ( 24 %) had titre between 100 and 1000 IU/L and one ( 3 %) patient had level of 10-99.99 IU/L. Conclusions In HIV-infected children who have no or mild immunosuppression, four dose, double dose schedule of HBV vaccine achieves very high seroconversion rates.