ABSTRACT
Background. Hepatitis B virus (HBV) remains a global health issue, leading to complications including cirrhosis and hepatocellular carcinoma. Individuals co-infected with Human Immunodeficiency Virus (HIV) and HBV have increased liver- related morbidity and mortality compared to those with HBV mono-infection. Vaccination can effectively prevent HBV infection, but certain critical populations including people living with HIV (PLWH) are less likely to achieve seroprotection (antibody to hepatitis B surface antigen (HBsAb) titer ≥ 10 IU/mL) after vaccination;seroprotection rates (SPR) in PLWH range from 34 to 88% in clinical trials, with improved SPR in those with immunologic reconstitution and viral suppression. With improved immunologic status, SPR have dramatically improved in our Veteran Infectious Disease clinic population. However, a subset of patients remain HBV vaccine nonresponders despite re-vaccination attempts, perhaps due to intrinsic immunologic anergy. We hypothesized that Veterans with HIV who were nonresponders to prior HBV vaccines may respond to a more immunogenic vaccine. Heplisav-B is a 2-dose series, with improved SPR in other classically difficult to vaccinate groups (including the elderly and those with diabetes), but has not yet been studied in individuals with HIV. Methods. HBV vaccine nonresponders who had previously been vaccinated and boosted with median 3 and up to 8 doses of alum-adjuvanted HBV vaccines were re-vaccinated with Heplisav-B. HBsAb titers were assessed at days 0, 30, and 60 to follow vaccine responses. Results. Participants had a median age of 65 (range 44 to 83) and were virologically suppressed on antiretroviral therapy. Enrollment and vaccination was interrupted by the COVID-10 pandemic, but 8 of 10 (80%) enrolled participants had seroprotective titers at day 60, with 6 having titers > 1000 IU/mL. Of the 8 additional participants who had available serologies after the first dose, all were seroprotected, and 3 had titers > 1000 IU/mL.16 of 18 (89%) participants achieved seroprotection with Heplisav-B. Conclusion. Heplisav-B is immunogenic in persons with HIV and should be a reasonable option for HBV vaccination of PLWH who are previous nonresponders.
ABSTRACT
Background: The COVID-19, due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with abnormal liver tests suggestive of hepatocellular injury While the incidence of elevated serum liver biochemistries in hospitalized patients with COVID-19 ranges from 14% to 58%, the impact of concomitant viral hepatitis on outcomes, particularly in patients with underlying immune dysregulation due to HIV, who become infected with SARS-CoV-2 is not known Methods: The CURE HIV-COVID Registry was created by the Institute of Human Virology, University of Maryland, Baltimore (UMB) and Arizona Liver Health. RedCAP de-identified web-based surveys were utilized and the study was deemed to be non-human subjects research Clinicians were encouraged to enter data on the clinical course of their patients with HIV who presented with COVID-19 at time of recovery or improvement, hospitalization or death Patient demographics, HIV CD4 count and viral load, ARV regimen, concomitant medications, comorbidities, concurrent AIDS-defining illnesses, COVID-19 treatment and management, COVID-19 related laboratory values were also collected Results: As of July 17, 2020, the CURE-HIV COVID registry included nine cases of HIV patients with active viral hepatitis who became infected with COVID-19 Three patients had chronic hepatitis B, five chronic hepatitis C and one patient with both HBV and HCV. All cases had laboratory confirmed SARS-CoV-2 diagnosis by positive reverse-transcriptase- polymerase-chain-reaction 50% of patients were active drug users, 75% active smokers and 77 8% had an HIV VL<200 copies/mL 44 4% of patients were black, 37 5% Hispanic and average CD4 was 419 8 +/- 377 4 cells/mm3 (Table 1) Among patients with HIV and HCV 80% had symptoms of COVID-19 and 1 (20%) was asymptomatic 60% of patients with HIV and HCV had cardiovascular comorbidities or cirrhosis and 80% of these patients were hospitalized requiring supplemental oxygen Among three patients with HIV, HBV and COVID-19, 66 7% were symptomatic, all had comorbid cardiovascular disease, and none were hospitalized One patient HIV, HBV and HCV was symptomatic but was not hospitalized No patients with HIV, Hepatitis B and/or C and COVID-19 required mechanical ventilation or died Conclusion: Overall, in this small case series patients with HIV and Hepatitis B and/or C who had COVID-19 had good outcomes including low rates of hospitalization, ventilation, and death Patients had mild elevations in ALT and AST during their infection Patients with chronic hepatitis C had higher rates of cardiovascular comorbidities and hospitalizations and may require additional care if infected or counseling to prevent infection or complications Further data should be gathered to understand the prognosis of HIV patients with viral hepatitis with are infected with SARS-CoV-2, and additional data will be presented(Table Presented).