Hepatitis B vaccines
Hepatitis B vaccines
Hepatitis B virus (HBV) vaccination is highly recommended for individuals with HIV-infection. Globally, the introduction of routine HBV vaccination has resulted in a significant decrease of HBV infection and the overall disease burden 45,49.
Co-infection with HBV and HIV is considered endemic in sub-Saharan Africa including South Africa. Both viruses share the same routes of infection and it is estimated that the prevalence of chronic HBV in HIV-infected individuals ranges from 0.4%-23% in South Africa 50.
The overall global prevalence of co-infection is around 10%, but this estimate varies from region to region. The rates of HBV infection among HIV-infected individuals is estimated to be 20-times higher than among HIV-uninfected persons 45,51.
In South Africa HBV vaccination has been part of the childhood immunisation programme since April 1995. Although vaccination coverage against HBV in childhood is high 52, many adults who born before 1995 were not vaccinated earlier in life and remain at high risk of HBV infection 53.
The administration of vaccines against HBV among HIV-infected individuals has been shown to be safe in many studies 54. However, immunologic responses are diminished 45. A successful response to HBV vaccination is most frequently associated with an undetectable HIV viral load and a cell CD4+ counts above 200 cells/µL 55.
The international recommendation for administration of vaccines against HBV is a four-double-dose regimen of a recombinant HBV vaccine (40 µg) at 0, 1, 2 and 6 months 56.
However the WHO recommendation is a three-dose regimen of recombinant HBV vaccine (20 µg) at 0, 1 and 6 months 54. The double-dose regimen induces higher peak anti-HBs antibody titres than the standard-dose regimen but no clear difference in the proportion of adults with protective antibodies up to five years after vaccination 8,57,58,59.
The British HIV Association (BHIVA) and the ACIP both recommend serologic antibody testing one month and 6-8 weeks, respectively, following administration of the last dose of the vaccine 45.
The panel supports the four-double-dose regimen HBV vaccine schedule. If this is not possible, then the standard regimen should be administered. The panel does not recommend serologic antibody testing and is only advised for healthcare workers or others at high-risk.