Hello dear Dr. McGovern, I am writing to ask about vaccination against hepatitis A and B. I read here on this website that all people who are HIV positive and men who have sex with men should be vaccinated against hep B and hep A. That is the reason why I got vaccination against hepatitis B but one month after 3 single doses (0,1 and 6 months) of engerix B my antibody levels were only 5mIU/ml (it is suposed to be more than 12 to be succesful) and then I read in internet that people who are HIV+ should receive double doses instead of single doses. After that I received one double dose and after one month another double dose and check my antibody level and it was 189 mIU/ml. Now I would be very greatfull if you respond to 2 my questions: 1) For how long period with this antibody level I am safe against infection, I mean when I have to check again level of antibodies for B? 2) I want to do vaccination against hep A and I wander if I have to take double dose at the beginning and than after 6 months another double dose, or first to try with single dose? I buy this vaccine on my own since you can`t be vaccinated here in Serbia and my brother (he is student of medicine) vaccinates me. I forgot to tell you that on my last blood test cd4 cells were 390. ARV treatment starts here when cd4 cells are below 300. I do hope you will have enough time to answer my questions. Thanks very much! Petar

Good questions.

You point out a very important issue for HIV infected patients. Hepatitis B vaccine leads to protection in greater than 90 percent of individuals, but those with HIV infection have lower rates of efficacy.

There are some data to suggest that a double dose of hepatitis B vaccine leads to better rates of protection. There are also several papers to show that HIV infected patients who have a nondetectable HIV viral load (on antiretroviral therapy) have better response rates than patients who have ongoing viremia (virus in the blood).

Some experts recommend yearly checks of the surface antibody to make certain that the levels remain high in patients who are at high risk of hepatitis B. So it depends on your risk. However, your levels are very high which is very reassuring that they will be protective for several years.

There are no data that I am aware of to suggest that double doses of hepatitis A vaccine should be used. I would go with the routine dose and see what happens. Your CD4 cells are good so I am hopeful for a good response.

I have also included this URL which will take you directly to a medical document published by several guideline committees. If you look around page 115 you will find more information on hepatitis B vaccination. I was part of the committee that wrote the guidelines and I think the document may be helpful to your brother who is studying medicine.

http://www.hivma.org/content.aspx?id=9202#toi

Best regards from the US...