人类免疫缺陷病毒-1感染者对重组乙型肝炎疫苗的免疫应答

目的 比较HIV-1感染者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19例和HIV-1感染者20例分别在0、1、6个月肌内注射重组乙肝疫苗20 μg,并在第1、3次疫苗注射后1个月检测抗-HBs水平,高于10 mIU/mL即为阳性.抗-HBs水平比较采用几何均数进行单因素方差分析,两两比较用Scheffe法,率的比较用Fisher's精确概率检验.结果 健康对照组第1、3次疫苗注射后1个月,抗-HBs阳性血清转换者分别为10例和18例,而HIV-1感染组分别为3例和11例,两组比较差异有统计学意义(P=0.015、0.005).CD4+T淋巴细胞≥200×106/L的HIV-1感染者在第1、3次疫苗注射后1个月,抗-HBs阳性血清转换者分别为2例和6例,而CD4+T淋巴细胞＜200×106/L的分别为1例和4例,两组比较在第1次疫苗注射后1个月差异无统计学意义(P=0.202),在第3次疫苗注射后1个月差异有统计学意义(P=0.005).CD4+T淋巴细胞＜200×106/L组(A组)、CD4+≥200X106/L组(B组)和健康对照组(C组)完成3次疫苗接种后1个月抗-HBs水平分别为(101±210)、(529±704)、(5989±10 704)mIU/mL,三组比较差异有统计学意义(F=18.53,P＜0.001),A组分别与C、B组比较,差异有统计学意义(P＜0.001、＜0.05),B组与C组比较,差异无统计学意义(P=0.353).所有入组者对乙肝疫苗均有良好耐受.结论 HIV-1感染者接种乙肝疫苗后与HIV-1阴性者相比,血清转换率和抗-HBs水平降低,尤其是CD4+T淋巴细胞＜200×106/L组.

Immune responses in patients with human immunodeficiency virus-1 infection after vaccinated with recombinant hepatitis B virus vaccine

Objective To observe the difference of immune response to hepatitis B virus(HBV)vaccine between human immunodeficiency virus(HIV)infected and healthy individuals.Methods Twenty HIV infected and nineteen healthy individuals were injected intramuscularly with 20 μg of hepatitis B vaccine on month 0,1,6.The serum anti-HBs level was measured on the 30th day after the first and third injections,and the level ＞ 10 mIU/mL was considered positive.The data of anti-HBs level were changed into geometric mean and compared by one-factor analysis of variance,and paired comparison was done by Scheffe test.Comparison of rate was analyzed by Fisher's exact test.Results Anti-HBs positive in healthy group were respectively 10 and 18 one month after the first and third injection,but they were 3 and 11 in HIV infected group.The differences between the two groups were significant(P=0.015 and P=0.005,respectively).In HIV infected group,anti-HBs positive in patients with CD4+≥200×106/L were respectively 2 and 6,but they were only 1 and 4 in patients with CD4+ ＜200×106/L.The difference between the two groups was significant after the third injection(P=0.005),but not significant after the first injection(P=0.202).The serum anti-HBs levels measured 1 month after the third injection were(101±210),(529±704),(5989±10 704)mlU/mL,respectively,in CD4+ ＜200×106/L group(A),CD4+≥200×106/L group(B)and healthy control group(C).The difference of three groups was significant(F= 18.53,P＜0.001).The differences between A and C,A and B were significant(P＜0.001,P＜0.05,respectively).The difference between B and C was not significant(P=0.353).All recruited individuals tolerate well to HBV vaccine.Conclusions Compared with HIV-1 negative individuals,the anti-HBs seroeonversion rate and serum anti-HBs level are decreased in HIV infected patients,specially in patients with CD4+ ＜200×106/L.