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Hep B immunisation for hiv positive folks

Dec 29, 2008

Dear Robert, You are wonderful and your comments in this forum helped me a lot! I am HIV positive. The time of infection is between 2006 02 and 2006 09. I am not on meds and my numbers are as follows:

1. 2007 01 04. CD4 310, CD4% 29, VL263000. 2. 2007 04 04. CD4 342, CD4% 24%. VL was not measured. 3. 2007 09 01. CD4 717, CD4% 32%. VL was not measured. 4. 2008 04 01. CD4 510, CD4% 35. VL was not measured. 5. 2008 12 24. CD4 610, CD% 30. VL was not measured.

I am a gay man and I understood that it is very important to get hepatitis b vaccination. I would like to avoid coinfection. My HIV doctor informed me that the scheme and dose of vaccination for HIV positive folks are the same as for negative people. Therefore I went to other doctor to get immunization and I did not tell her that I am HIV positive. I was given TWINRIX vaccine (hepatitis A and B immunization). I was given three shots (second shot after a month, third shot after 6 months). However, six months after the last shot there was zero immunity against hepatitis B. When I was given the first shot, my cd4 was 717 and CD4% 35. My doctor suggested reimmunization with ENGERIX vaccine (three shots with interval of one month). Could you tell me if this decision is correct? Could you give me advice?

Thank you very much.

Response from Dr. Frascino


HIV-positive patients who do not respond to initial hepatitis B immunization should be revaccinated using the standard three-dose regimen. Either Recombivax HB or Engerix-B can be used. By the way, I didn't respond to my first series either.

Dr. Bob

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