Abstract:
In studies from high-income countries, human immunodeficiency virus type 1 (HIV-1)-infected
persons have diminished responses to hepatitis B virus (HBV) vaccination, compared with HIV-
1-uninfected persons, but data from other settings are limited. METHODS: We compared the
immune response to HBV vaccination among HIV-1-infected and HIV-1-uninfected Kenyan
adults and assessed the response of HIV-1-infected initial nonresponders to revaccination with a
standard HBV vaccine series. RESULTS: Of 603 participants, 310 (51.4%) were HIV-1-
infected, for whom the median CD4(+) T-cell count was 557 cells/μL (interquartile range, 428-
725 cells/μL); none were receiving antiretroviral therapy. Nonresponse to HBV vaccine was
higher among HIV-1-infected participants, compared with HIV-1-uninfected participants (35.8%
vs 14.3%; odds ratio, 3.33; P < .001). Of 102 HIV-1-infected initial nonresponders, 88 (86.3%)
responded to revaccination, for an overall response, including to revaccination, of 94.9%.
Among HIV-1-infected individuals, lower CD4(+) T-cell counts and male sex were independent
predictors of nonresponse to initial vaccination, and lower body mass index, higher plasma HIV-
1 RNA levels, and longer time to revaccination predicted nonresponse to revaccination.
CONCLUSIONS: Kenyan adults had similar HBV vaccination responses as persons from highincome
countries. Timely revaccination of HIV-1-infected nonresponders increased response to
the vaccine to 95%.
