Abstract:
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Hepatitis B and A account for considerable morbidity and
mortality worldwide. Immunization is the most effective means of
preventing hepatitis B and A. However, the immune response to
both hepatitis vaccines seems to be reduced in HIV-infected
subjects. The aim of this review was to analyze the
immunogenicity, safety, long-term protection and current
recommendations of hepatitis B and A vaccination among
HIV-infected adults. The factors most frequently associated with
a deficient level of anti-HBs or IgG anti-HAV after vaccination
are those related to immunosuppression (CD4 level and HIV RNA
viral load) and to the frequency of administration and/or the
amount of antigenic load per dose. The duration of the response
to both HBV and HAV vaccines is associated with suppression of
the viral load at vaccination and, in the case of HBV
vaccination, with a higher level of antibodies after
vaccination. In terms of safety, there is no evidence of more,
or different, adverse effects compared with HIV-free
individuals. Despite literature-based advice on the
administration of alternative schedules, revaccination after the
failure of primary vaccination, and the need for periodic
re-evaluation of antibody levels, few firm recommendations are
found in the leading guidelines. |