852. Calculated Globulin Levels Predict Hepatitis B Vaccine Response in HIV-Infected Persons with Viremic Suppression and High CD4 Cell Count
Session: Oral Abstract Session: HIV Co-Morbidities and Co-Infections
Thursday, October 27, 2016: 2:30 PM
Room: 275-277

Background:

HIV viral load (VL) and total IgG levels are associated with poor response to hepatitis B virus (HBV) vaccine in HIV-infected individuals.  IgG levels typically decline with combination antiretroviral therapy but do not always return to normal.  The clinical significance of this residual elevation is unclear.  We retrospectively examined the relationship of calculated globulin (CG) levels with HBV vaccine response in persons with suppressed VL and high CD4 cell counts among participants in the U.S. Military HIV Natural History Study (NHS).

Methods:  

NHS is a multicenter cohort of DoD active duty and beneficiaries with HIV infection.  Participants for this study had (1) no current or past HBV or hepatitis C infection (2) HBV vaccination after positive HIV date, (3) post-vaccination follow-up serum HBV surface antibody (HBsAb) test, (4) CD4 cell count ≥500 cells/ul and VL<50 copies/ml at time of the last vaccine dose. Using a standard approach, CG levels were derived by subtracting the albumin level from total protein.  Subjects were categorized by CG quartiles at time of last vaccine dose.  Chi-square, Kruskal-Wallis, and logistic regression analysis were used.

Results:

Data from 159 participants were analyzed.  Subjects were 87% male, 47% Caucasian, 40% African-American.  At time of last vaccine dose, median values were age, 40 yrs; CD4 cells/ul, 702; nadir CD4 cells, 318; and were similar across CG quartiles.  Median time of continuous viral suppression prior to last vaccine dose was 40 mos. 86% received ≥3 total vaccine doses, and 80% had ≥2 doses during viremic control.  Overall, HBV vaccine response rate was 72%.  Analysis by quartiles is shown below.

 

Calculated Globulin Quartile

 

1

1.7-2.6 g/dl

2

2.7-2.9 g/dl

3

3.0-3.2 g/dl

4

3.3-5.0 g/dl

HBV vaccine response*

82%

75%

71%

57%

OR (95% CI) Univariate

Ref

0.66 (0.23-1.87)

0.54 (0.20-1.57)

0.29 (0.11-0.78)

OR (95% CI) Multivariate**

Ref

0.63 (0.22-1.89)

0.37 (0.12-1.11)

0.26 (0.09-0.76)

*p=0.013

**Adjusted for age, gender, race, CD4 count, nadir CD4 count, and number of vaccine doses.

Conclusion:  

Higher CG levels appear to reflect graded immune dysfunction in the setting of HIV viral suppression.  New approaches to address persistent immune defects are needed and may benefit vaccine responses in those with HIV.

 


Thomas O'bryan, MD1,2,3, Chris Olsen, B.S.1,3, Syed Rahman, B.S.1,3, Anuradha Ganesan, MD, MPH4,5,6, Jason Okulicz, MD1,2, Tahaniyat Lalani, MD1,3,7, Robert Deiss, MD1,3,8 and Brian Agan, MD1,3, (1)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (2)San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, TX, (3)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, (4)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (5)Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (6)Infectious Disease, Walter Reed National Military Medical Center, Bethesda, MD, (7)Naval Medical Center Portsmouth, Portsmouth, VA, (8)Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, CA

Disclosures:

T. O'bryan, None

C. Olsen, None

S. Rahman, None

A. Ganesan, None

J. Okulicz, None

T. Lalani, None

R. Deiss, None

B. Agan, None

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