抗病毒治疗后HIV/AIDS病人对重组乙型肝炎疫苗的免疫应答

Immune Response to Recombinant Hepatitis B Vaccine among Patients With HIV/AID Receiving Antiretroviral Therapy

目的比较艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗反转录病毒治疗(ART)后,与健康者接种乙型肝炎(乙肝)疫苗后免疫应答的差异。方法健康对照者和ART后CD_4^+T淋巴细胞(简称CD_4细胞)计数均≥200个/μL的HIV/AIDS病人,分别在0、1、6个月肌内注射重组乙肝疫苗20μg,并在第3次疫苗注射后1个月检测抗乙肝病毒表面抗原抗体(抗-HBs)的水平,高于10 mIU/mL即为阳性。两组血清抗-HBs阳性率的比较采用卡方检验,抗-HBs效价的比较采用非参数检验中的Mann-Whitney检验。结果健康对照组19例,在第3次乙肝疫苗注射后1个月,抗-HBs阳性率94.7%(18例);HIV/AIDS病人组30例,在第3次乙肝疫苗注射后1个月,抗-HBs阳性率93.3%(28例);两组比较差异无统计学意义(P=1.000)。CD_4细胞≥350个/μL组HIV/AIDS病人23例,第3次乙肝疫苗注射后1个月,抗-HBs阳性率95.7%(22/23);CD4细胞<350个/μL、>200个/μL组7例,第3次乙肝疫苗注射后1个月,抗-HBs阳性率85.7%(6/7),两组比较差异无统计学意义(P=0.418)。CD_4细胞≥350个/μL组在第3次乙肝疫苗注射后1个月,血清抗-HBs效价中位数为251.24mlU/mL,CD_4细胞<350个/μL、>200个/μL组在第3次乙肝疫苗注射后1个月,抗-HBs效价中位数为237.6mlU/mL,两组比较差异无统计学意义(Z=-0.368,P=0.737)。所有接种者均未出现不良反应。结论 ART后,CD_4细胞计数≥200/μL的HIV/AIDS病人,对乙肝疫苗接种能获得相对较好的免疫应答,因此针对严重免疫抑制的HIV/AIDS病人,为提高接种乙肝疫苗的应答效果,较好的接种时机可选择在ART后且CD4细胞计数≥200个/μL时。

Objective To understand the differences of immune response to recombinant hepatitis B vaccine between the patients with human immunodeficiency virus（HIV）/Acquire immunodeficiency syndrome（AIDS）receiving antiretroviral therapy and the healthy persons as the control group.Methods Both healthy group（19cases）and patients group（30cases）with antiretroviral treatment of CD4^＋ T lymphocyte counts≥ 200cell/μL received three shots of recombinant hepatitis B vaccine（20μg for each）at the birth,3 and 6months respectively,and anti-HBs was detected after one month of the third shot.Anti-HBs〉10 mIU/mL was regarded as positive.Chi square test was used to compare anti-HBs positive rates of the two groups,and Whitney-Mann test of non-parametric test used to compare anti-HBs titer.Results Theanti-HBs positive rate of control group was 94.7%（18/19）;and that of the patients group was 93.3%（28/30）;the difference between the two groups was not statistically significant（P=1.000）.Among the patients group,23 cases with CD4^＋ T lymphocytes≥350cell/μL had their anti-HBs positive rate of 95.7%（22/23）;and 7cases with CD4^＋ T lymphocytes≥200cell/μL had the anti-HBs positive rate of 85.7%（6/7）;the difference was not statistically significant（P=0.418）.The serum anti-HBs titers of the 23 cases was a median 251.24mIU/ml,and those of the 7cases was a median 237.6mIU/ml;the difference between the two groups was not statistically significant（Z=-0.368,P = 0.737）.All vaccinated people had no adverse reactions.Conclusion The patients with anti-retroviral treatment,and their CD4^＋ T lymphocyte counts≥ 200cell/μL can get relatively good immune response to hepatitis B vaccination.So CD4^＋ T lymphocyte counts ≥200cell/μL should be the proper time for the patients with HIV/AIDS and severe immune suppression to take hepatitis B vaccine,which can improve the efficacy of the vaccine.