Adherence to hepatitis A virus vaccination in HIV-infected men who have sex with men.

Although vaccination against hepatitis A virus (HAV) is essential for human immunodeficiency virus (HIV)-infected patients, the uptake of HAV vaccine is reported to be very low. From 2007 to 2012, 912 HIV-infected men in Athens, Greece were screened for exposure to HAV. Two doses of an HAV vaccine were recommended to 569 eligible patients. Reminder cards with scheduled vaccination visits were given to each patient. Among eligible patients, 62.2% (354/569) received both doses. Patients who were fully vaccinated compared with non-adherent patients were natives, older, had undetectable HIV viral load, higher CD4 T cell counts and lower nadir CD4 T cell counts. Multivariate logistic regression revealed that the patient's country of origin (p = 0.024; OR = 2.712; 95% CI, 1.139-6.457), CD4 T cell count (p < 0.001) and nadir CD4 T cell count (p < 0.001) were factors directly associated with adherence. In conclusion, adherence to HAV vaccination was better than in previously published data. Because many of the factors related to vaccination completion are parameters of HIV infection, it appears that physician interest in HIV care and vaccination planning is crucial to enhancing vaccine uptake.

Prevalence and titre of antibodies against Hepatitis A virus in HIV-infected men having sex with men in Greece.

Hepatitis A remains a serious vaccine-preventable disease for HIV patients. We tested 897 HIV-infected men having sex with men (MSM) for antibodies against hepatitis A virus (anti-HAV) and measured the geometric mean antibody titres (GMTs) in a group of patients who received a hepatitis A vaccine and in patients with immunity to HAV due to infection in childhood. In all, 320 patients (35%) had positive anti-HAV antibodies. Multivariate analysis showed that only age (p 0.001) and ethnic origin (OR 20.029, p 0.001) had a statistically significant effect on the presence of antibodies. In addition, age was a fairly sensitive (68.4%) and specific (64.2%) marker, patients being separated by the 36.5 years cut-off point. The response rate of patients who get vaccinated (n 383), one month following the administration of the second dose of the vaccine, was 76%. The GMT of the vaccinated patients was 305 mIU/ml versus 7105 mIU/ml of patients with past infection. The vast majority of HIV-infected MSM patients in Greece is susceptible to HAV. Immunity to HAV in newly vaccinated patients, unlike patients with natural immunity, is low and probably requires monitoring.

Hepatitis A vaccination and immunological parameters in HIV-infected patients.

Vaccination against hepatitis A is an important intervention to prevent disease in HIV-patients. There are insufficient data on the association of the response to hepatitis A vaccine with immunological parameters, including subpopulations of T-cells. We studied HIV-infected adults with CD4 T-cells>200 cells/mm(3) who received two doses of hepatitis A vaccine (Havrix or Vaqta). The counts of CD3, CD4, CD8, CD4+T-cells, NK, NK CD8+, NK CD8 - cells, and HIV RNA were measured at the time of first dose administration and one month after the end of the vaccination period. The geometric mean titer of antibodies to hepatitis A virus (anti-HAV) and factors affecting response were evaluated. 113 patients (50 antiretroviral treatment-naïve and 63 treatment-experienced) were enrolled in the study. There was no change in the immunological parameters and in the HIV-RNA post-vaccination, except for a decrease in CD8 and in double positive CD4+CD8+t-cell count. The immune response and geometric mean titer of anti-HAV were similar among treated and naïve patients (78% vs. 76% and 237 mIU/mL vs. 158 mIU/mL). Vaccine response was achieved in 71% of patients with CD4=200-499 cells/mm(3) compared with 80% of participants with CD4 ≥500 cells/mm(3) (p>0.05). Logistic regression revealed that immunological cells tested do not affect response differently in treatment-naïve vs. experienced patients. The only factor affecting response is the CD4 T-cell count at vaccination (OR 1.320; 95% CI 1.052-1.656; p=0.016). Patients with CD4 T-cell count ≥500 cells/mm(3) were 4.3 times more likely to respond to the vaccine than patients with CD4 T-cell count 200-499 cells/mm(3) (p=0.005). In conclusion, successful vaccination is associated with CD4 T-cells. The count of other immune cells or the administration of antiretroviral therapy does not predict response to hepatitis A vaccine in HIV patient with baseline CD4 T-cell>200 cells/mm(3).

Adherence to antiretroviral therapy among HIV-infected prisoners.

Adherence, the act of following a course of medication in exactly the manner prescribed, is critical for the success of therapy. Adherence is influenced by many behavioural and social factors and incarceration might be one such factor. This study determined the level of adherence and reasons for non-adherence to antiretroviral therapy among 93 HIV-infected prisoners. Up to 56% of these patients had poor adherence. A similar rate of adherence was detected in prisoners after release. Problems with antiretroviral adherence among prisoners appear to be mostly linked to their deviant behaviour. Inmates with poor adherence had higher HIV-related morbidity and mortality. Age and country of origin were also associated with adherence.