Serological response with Heplisav-B® in prior Hepatitis B vaccine non-responders living with HIV.

BACKGROUND: As people living with HIV (PLWH) are at risk for contracting Hepatitis B Virus (HBV), they should be screened for HBV and vaccinated if not immune. Seroconversion rates in PLWH receiving traditional recombinant HBV vaccines (Engerix-B® and Recombivax-HB®) have historically been low with at most 70% achieving immunity. In 2017, a recombinant, adjuvanted HBV vaccine (Heplisav-B®) was approved for use in HIV-negative patients. Heplisav-B® has shown superior seroprotection in this population compared to Engerix-B® and Recombivax-HB®, as well as interim analysis showing higher seropositivity rates in patients undergoing dialysis. However, its efficacy in PLWH is currently unknown. This study evaluates the rate of seroconversion following Heplisav-B® administration in PLWH with previous HBV vaccination failure. METHODS: Retrospective, cross-sectional study at The Brooklyn Hospital Center's HIV primary care clinic in Brooklyn, NY. HIV-positive adults who received at least two doses of Heplisav-B® and had previously failed to seroconvert after vaccination with Engerix-B® or Recombivax-HB® were included. The primary outcome is the percentage of PLWH who became seropositive following Heplisav-B®. RESULTS: A total of 67 patients met the inclusion criteria. Twenty-five (37.3%) PLWH had failed at least 2 courses of recombinant vaccines. Fifty-eight (86.6%) PLWH became seropositive (Anti-HBs > 10 mIU/mL) at least two months after completing Heplisav-B®. For the 9 (13.4%) patients that did not develop immunity, 3 (33%) had a detectable HIV RNA and 3 (33%) had a CD4 count < 200 cells/uL3. CONCLUSIONS: Heplisav-B® was highly effective in achieving immunity to HBV in PLWH who failed non-adjuvanted recombinant vaccines.

Concomitant Treatment of Hepatitis C Virus and Diffuse Large B-Cell Lymphoma with Direct-Acting Antivirals in HIV Coinfection: A Case Report.

This report describes a case of concomitant treatment of advanced diffuse large B-cell lymphoma with chemoimmunotherapy along with direct-acting antivirals for hepatitis C virus in a patient coinfected with HIV. The patient tolerated gemcitabine, dexamethasone, cisplatin, and rituximab and achieved sustained virologic response after treatment with ledipasvir/sofosbuvir.

Real-World Experience With Higher-Than-Recommended Doses of Lamivudine in Patients With Varying Degrees of Renal Impairment.

BACKGROUND: Although nucleoside reverse transcriptase inhibitors have been associated with lactic acidosis, lamivudine (3TC) has not been reported to have an increased risk with elevated concentrations. Therefore, some recommend that the lowest tablet strength of 3TC be considered in patients with kidney disease to avoid the inconvenience of liquid formations. Our institution avoids dose-adjusting 3TC until creatinine clearance (CrCl) <30 mL/min and uses 100-150-mg tablets daily in hemodialysis. The aim of this study was to describe the use of higher-than-recommended doses of 3TC in a real-world setting. METHODS: Blood samples were collected before and 0.5-1.5 hours after 3TC administration in HIV+ adults. Predose (Cmin) and postdose (Cmax) samples were measured by high-performance liquid chromatography. Physiologically based pharmacokinetic modeling was utilized to simulate areas under the curve (AUCs) and profiles by CrCl. Lactic acid levels and patient-reported adverse events were obtained to monitor for safety, and viral suppression was assessed for efficacy. RESULTS: Thirty-four patients with varying degrees of renal function were enrolled. Observed 3TC Cmax values were comparable among CrCl cohorts. Simulated 3TC AUC values in patients with CrCl 30-49, 15-29, and 0-15 mL/min were consistent with historical data, and fold-errors were between 0.5 and 2.0. All lactic acid levels were within normal limits, and no adverse effects were reported. CONCLUSIONS: This study is the first to describe the use of higher-than-recommended doses of 3TC in a real-world setting. 3TC was well tolerated across all levels of renal function. These results can guide providers in their selection of higher 3TC dosing in select patients with renal dysfunction to maximize adherence.

Recurrent Primary Suprahepatic Abscess Due to Providencia Stuartii: A Rare Phenomenon.

Gram-negative urease-producing bacilli, Providencia stuartii (P. stuartii), is reported in urinary tract infections, gastroenteritis, and bacteremia in humans but they rarely present with a hepatic abscess. We present a rare case of a recurrent suprahepatic cyst due to P. stuartii in a 45-year-old female, intravenous ( IV) heroin abuser with chronic hepatitis B and C. A 45-year-old female with 10 days status post right suprahepatic abscess drainage presented with recurrent, right, upper quadrant abdominal pain for one day. The pain was 7/10, sharp, radiated to the right back, and was associated with nausea, non-bloody non-bilious vomiting, and right-sided pleuritic chest pain. She was discharged after interventional radiology (IR) drainage of the abscess and completed 14 days of levofloxacin and metronidazole. On palpation, mild tender hepatomegaly was noticed. Complete blood count showed leukocytosis of 17.1 with left shift but liver enzymes within normal limits. Aspirated fluid cultures from the abscess showed P. stuartii. Blood and urine cultures were negative. A human immunodeficiency virus (HIV) test was negative. Hepatitis B virus (HBV) deoxyribonucleic (DNA) polymerase chain reaction (PCR) showed > 17 million IU/ml and hepatitis C virus (HCV) Ab reactive. A right, upper quadrant sonogram showed 4.1x0.9x2.7 cm fluid collection anterior to the right liver lobe. A computed tomography (CT) abdomen showed a dominant 5.2x5.5x3.9 cm hypodense lesion consistent with an abscess above the right liver. Initially, she was treated empirically with IV piperacillin-tazobactam and anticoagulation for a pyogenic liver abscess (PLA). Clinical and laboratory improvement were achieved with intravenous antibiotics evidenced by the decreasing size of the abscess on repeat CT scan. The patient was discharged with continuing antibiotics after four weeks. Repeated CT scan showed complete resolving of the suprahepatic cyst. In conclusion, in our patient, long-term shelter residence, IV heroin use, and chronic hepatitis B and C might be precipitating factors for PLA. Managing a recurrent primary hepatic abscess caused by P. stuartii is similar to PLA from other bacterial causes: drainage and antibiotic therapy. However, in our case, she responded well to medical treatment without further surgical drainage.