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HELP! Twinrix Hep A/B Vaccine NOT working! ***SECOND TIME ASKING***
Sep 9, 2007

I was diagnosed with Aids in 2002 with a cd4 of 2 and a vl of 175,000. Shortly after starting Kaletra and Combivir in 2003 I had my first round of Twinrix (hep a/b vaccination). After a few months a blood test revealed that the vaccine did not work. My HIV specialist speculated that it may have been due to my counts being so bad. Anyway, I was given the vaccine again in 2006 with a CD4 of 450 and an undetectable viral load. Still the vaccine did not work. My HIV Doc is reluctant to try the vaccine a third time. He is researching this issue. What is your opinion or experience with this situation?

Response from Dr. McGovern

I would consider a double dose of the hepatitis B vaccine. This has been studied in one trial and there was some benefit in non-responders like you. The double dose is the same dose given to dialysis patients.

Recently there was also some work done with adjuvants that help the vaccine work better. The results are promising, but the adjuvant is not yet available.

I would also have your physician considering checking your hepatitis B DNA to be certain that you do not have "occult hepatitis B". I would put this possibility as very low on the problem list, but prudent to check.



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