Honghong Yang, Xiang Du, Zhang Lvlang, Tongxin Li, Pengle Guo, Jingmin Nie
The long-term durability of the immune response after primary hepatitis B (HBV) vaccination in people living with HIV (PLWH) remains unclear. This real-world study aimed to assess HBV vaccination immunogenicity in PLWH and explore the factors influencing long-term immunogenicity. A total of 195 PLWH with baseline anti-HBs < 10 IU/mL who received ≥1 dose of Heplisav-B vaccine and underwent anti-HBs measurement at 7–9 months after the first dose were retrospectively analyzed. Longitudinal follow-up of 1.5–8.5 years was conducted to evaluate long-term trend of anti-HBs titer. The study population was predominantly male (88.2%), with a median baseline CD4 + cell count of 351.8 cells/μL, and 81.0% had undetectable HIV RNA at baseline. In total, 44 (22.5%), 38 (19.5%), 100 (51.3%), and 13 (6.7%) PLWH received 1, 2, 3, and 4 vaccine doses, respectively. The initial immune response (7–9 months post-dose 1) was dose-dependent, with rates of 77% (1 dose), 79% (2 doses), 98% (3 doses), and 85% (4 doses). Compared with the 1- and 2-dose regimens, both the 3- and 4-dose regimens induced significantly higher response rates, characterized by a predominance of high responses (HRs). Over the 8.5-year follow-up period, response rates gradually decreased across all the groups. However, the 3- and 4-dose groups reached superior durability (83 and 88% response rates at year 8.5 years post-dose 1, respectively), with median anti-HBs titers persistently >100 IU/mL. Multivariable analysis revealed the number of vaccine doses and a robust early serological response were consistent independent correlates of antibody persistence at 3.5, 5.5, and 8.5 years post-dose 1, with HIV RNA negativity additionally emerging as a key factor related to the 8.5-year outcome. These findings suggest that a complete 3- or 4-dose HBV vaccination series, coupled with an early serological response, is associated with sustained long-term antibody persistence in PLWH.