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Hepatitis A Vaccine Response Durable in People with HIV

People with well-controlled HIV infection respond well to hepatitis A vaccination, with 89% achieving an initial response and 85% still protected after 6-10 years.

Hepatitis A virus (HAV) can cause more aggressive liver disease in people with HIV, and experts recommend that individuals who are diagnosed as HIV positive should be vaccinated against hepatitis A and B (there currently is no effective hepatitis C vaccine).

As described in the June 2011 Journal of Infectious Diseases, Nancy Crum-Cianflone and fellow investigators with the Infectious Disease Clinical Research Program HIV Working Group looked at durability of HAV vaccine protection in the HIV positive population.

This retrospective analysis included 130 HIV positive adults in the U.S. Military HIV Natural History Study; most were men and the median age was 35 years. The median CD4 cell was quite high, at 461 cells/mm3 (near the threshold for starting antiretroviral treatment according to current U.S. guidelines), and about half had HIV RNA viral load < 1000 copies/mL; 62% were taking antiretroviral therapy (ART).

All participants received the standard 2 doses of HAV vaccine. The researchers analyzed blood specimens collected at 1 year, 3 years, and, if available, 6 to 10 years after vaccination. HAV immunoglobulin G (IgG) antibody levels of 10 mIU/mL or greater were considered protective.


  • 89% of HIV positive participants achieved initial vaccine responses, compared with 100% of HIV negative historical controls (that is, results seen in prior studies).
  • Among HIV positive initial responders with available follow-up specimens, longer-term response rates remained high:
  • 89% protection at 1 year;
  • 90% still HAV antibody positive after 3 years;
  • 85% still protected after 6 to 10 years.
  • However, average HAV antibody concentrations were lower in HIV positive people compared with HIV negative controls:
  • 1 year: 154 vs 1734 mIU/mL, respectively;
  • 3 years: 111 vs 687 mIU/mL, respectively;
  • 6-10 years: 64 vs 684 mIU/mL, respectively;
  • People with CD4 cell counts > 350 cells/mm3 when vaccinated were more likely to achieve an initial response than those with lower levels (94% vs 78%, respectively), but this was no longer statistically significant at 3 years.
  • Over time, among HIV participants, higher HAV antibody levels were significantly associated with low HIV viral load.

Based on these findings, the investigators concluded, "Most adults with well-controlled HIV infections had durable seropositive responses up to 6-10 years after HAV vaccination."

"[M]aintaining suppressed HIV RNA levels among HIV-infected persons may be an important strategy for sustaining durable antibody levels for vaccine preventable infections such as hepatitis A virus," they suggested.

Investigator affiliations: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Infectious Disease Clinic, Naval Medical Center San Diego, CA; Merck Research Laboratories, North Wales, PA; Infectious Disease Service, San Antonio Military Medical Center, TX; Infectious Disease Clinic, Walter Reed Army Medical Center, Washington, DC; Infectious Disease Clinic, National Naval Medical Center, Bethesda, MD; Infectious Disease Clinic, Naval Medical Center Portsmouth, VA; Infectious Disease Clinic, Orlando Regional Medical Clinic, FL.


NF Crum-Cianflone, K Wilkins, AW Lee, et al (Infectious Disease Clinical Research Program HIV Working Group). Long-term Durability of Immune Responses After Hepatitis A Vaccination Among HIV-Infected Adults. Journal of Infectious Diseases 203(12):1815-1823.