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Author Topic: Low CD4 and HepB vaccination  (Read 1627 times)

0 Members and 7 Guests are viewing this topic.

Offline multifan

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  • Posts: 14
Low CD4 and HepB vaccination
« on: January 08, 2021, 11:49:32 am »
Hi.
I've never been vaccinated against HepB. My HbS-Ab result is negative, there aren't HepB antibodies. I'm HepB and HepC negative. I'm 37, I'm sexually active and I'm still afraid about contracting another virus. I perform the HBsAg test every three months. I take Triumeq, which contains Lamivudine, and it also works as the HepB inhibitor.
I'd like to get the HepB vaccine. I read much about HepB vaccination with low CD4s.
My GP doc got me Engerix B in 2018, but there wasn't any response, my CD4 was extremely low at that time and I got a prophylaxis (Daraprim and Sulfadiazine). I read I should get a double dose, but my GP didn't know about it, she got me a single dose. My ID currently claims my CD4's are still too low to get the vaccine.
When I talk to her I'm at high risk, she changes the subject to the weather for example.
What do you think about it? Should I consult it with the other HIV doc in the gay friendly PrEP clinic and try again? Or should I wait a few years until my CD4s will raise or I contract the HepB virus?
Did anyone get the Hep vaccine at low CD4?
Thank you in advance for your help.
« Last Edit: January 08, 2021, 12:10:18 pm by multifan »
OI - CNS Toxoplasmosis, oral candidiasis
17/05/2018  CD4 - 27  VL 188.000 Dexamethasone i.v., Sulfadiazine 2x3g, Daraprim 75mg, Leucovorin 15mg 1xd, Azithromycinum 1xweek 600mg
31/05/2018  start Triumeq
21/06/2018  discharge from hospital
08/07/2018  CD4 - 124  VL 37 Sulfadiazine 1.5g2xd, Daraprim 50mg 1xd, discontinue Azithromycinum
14/08/2018  CD4 - 110 11%
10/10/2018  CD4 -  94  9% 
16/10/2018  CD4 - 154 VL <20
16/11/2018  CD4 - 180 VL<20
20/01/2019 CD4 140 VL<20
29/06/2019 CD4 220 VL <20 13%
29/08/2019 CD4 180  13%
25/09/2019 CD4 220  14%  CD4/CD8 0.31 discontinued Daraprim/Sulfadiazine
18/05/2020 CD4 220 12%
21/08/2020 VL - 39, Chlamydia Trachomatis
08/01/2021 CD4 240 13% CD4/CD8 0.4
03/03/2021 CD4 280 14% CD4/CD8 0.3 VL<40

Online Jim Allen

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Re: Low CD4 and HepB vaccination
« Reply #1 on: January 08, 2021, 02:20:47 pm »
Hiya.

I always thought Hepatitis B vaccine was inactivated and could be given at any CD4 count although there might be lower response rates. Might be wrong and open to correction.

Recall that I was vaccinated with the 3 injections over 6 months, it did not work and I so I did it a 2nd time and the same result. 3 times over 6 months matches up with the immunisation guidelines here.

Look it can't hurt to get a 2nd opinion from another Doctor particularity if this one is not willing to talk openly about sex and vaccinations. You might be able to find additional info on the vaccination or ask under the "Am I" section on the hepatitis forums for more info. Pretty sure Lynn K knows more about it than I do. https://forums.hepmag.com/

https://www.hse.ie/eng/health/immunisation/pubinfo/adult/hepb/
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline multifan

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  • Posts: 14
Re: Low CD4 and HepB vaccination
« Reply #2 on: January 08, 2021, 03:51:52 pm »
Thank you for your reply and your advice.
Did you eventually respond to the Hepatitis B vaccine?
Engerix B is a recombinant vaccine. There isn't a live virus, it contains only a surface antigen of the virus. This vaccine is 100% safe for PLHIV at any CD4s count. Unfortunately, many of the PLHIV don't produce antibodies to this vaccine due to their weakened immune system.
Many guidelines advise to perform screening of the HbsAb about 4 weeks after administering the first dose. If there isn't any response (HbsAb<10/ul) to the first dose, the second and third one should be doubled.
Now, I know I shouldn't put it off to the distant future, because it can be too late for me and there is hope I'll respond to the boosted dose.
Only Doctor can perform immunization, so go to the gay friendly clinic will be the best choice for me.
I'll certainly write what the second Doctor says.
« Last Edit: January 08, 2021, 03:59:31 pm by multifan »
OI - CNS Toxoplasmosis, oral candidiasis
17/05/2018  CD4 - 27  VL 188.000 Dexamethasone i.v., Sulfadiazine 2x3g, Daraprim 75mg, Leucovorin 15mg 1xd, Azithromycinum 1xweek 600mg
31/05/2018  start Triumeq
21/06/2018  discharge from hospital
08/07/2018  CD4 - 124  VL 37 Sulfadiazine 1.5g2xd, Daraprim 50mg 1xd, discontinue Azithromycinum
14/08/2018  CD4 - 110 11%
10/10/2018  CD4 -  94  9% 
16/10/2018  CD4 - 154 VL <20
16/11/2018  CD4 - 180 VL<20
20/01/2019 CD4 140 VL<20
29/06/2019 CD4 220 VL <20 13%
29/08/2019 CD4 180  13%
25/09/2019 CD4 220  14%  CD4/CD8 0.31 discontinued Daraprim/Sulfadiazine
18/05/2020 CD4 220 12%
21/08/2020 VL - 39, Chlamydia Trachomatis
08/01/2021 CD4 240 13% CD4/CD8 0.4
03/03/2021 CD4 280 14% CD4/CD8 0.3 VL<40

Online Jim Allen

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Re: Low CD4 and HepB vaccination
« Reply #3 on: January 08, 2021, 05:31:29 pm »
Quote
Did you eventually respond to the Hepatitis B vaccine?

No, i did not.
HIV 101 - Everything you need to know
HIV 101
Read more about Testing here:
HIV Testing
Read about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read about HIV prevention here:
HIV prevention
Read about PEP and PrEP here
PEP and PrEP

Offline harleymc

  • Member
  • Posts: 1,440
Re: Low CD4 and HepB vaccination
« Reply #4 on: January 10, 2021, 11:28:24 pm »
Don't freak out about lack of antibodies.  Lots of people living with HIV are non responders.


The antibodies are short lived at best.  However the good news is there appears to be some training of our T cells.

The double dosing of the hep b vaccination seems to be fairly recent practice, it doesn't do any harm.

Offline daveR

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  • Posts: 201
Re: Low CD4 and HepB vaccination
« Reply #5 on: January 12, 2021, 12:16:04 am »
I had two attempts at the 3 injection Hep B vaccine several years apart. Neither were successful. About 9 months ago my ID tried a single booster injection during my six months check up. She then checked again at my next six months check up and was pleased with my immune response. I now have enough antibodies to protect me, she did however give me another shot as she wants to induce an even stronger reaction. I will get the results of that in April.

Unfortunately I cannot remember what the injection was, all I know is that it is the only one that has ever worked for me.

Offline multifan

  • Member
  • Posts: 14
Re: Low CD4 and HepB vaccination
« Reply #6 on: January 12, 2021, 07:43:56 am »
DaveR, thank you for your reply, you get me a hope.
What were your CD4s when you eventually got a response? What were your CD4 during your unsuccessful attempts? As you can see, my CD4s currently are 240, and they raise slowly.
As I mentioned above, I have to go to the other ID doc to get a 2nd opinion.
OI - CNS Toxoplasmosis, oral candidiasis
17/05/2018  CD4 - 27  VL 188.000 Dexamethasone i.v., Sulfadiazine 2x3g, Daraprim 75mg, Leucovorin 15mg 1xd, Azithromycinum 1xweek 600mg
31/05/2018  start Triumeq
21/06/2018  discharge from hospital
08/07/2018  CD4 - 124  VL 37 Sulfadiazine 1.5g2xd, Daraprim 50mg 1xd, discontinue Azithromycinum
14/08/2018  CD4 - 110 11%
10/10/2018  CD4 -  94  9% 
16/10/2018  CD4 - 154 VL <20
16/11/2018  CD4 - 180 VL<20
20/01/2019 CD4 140 VL<20
29/06/2019 CD4 220 VL <20 13%
29/08/2019 CD4 180  13%
25/09/2019 CD4 220  14%  CD4/CD8 0.31 discontinued Daraprim/Sulfadiazine
18/05/2020 CD4 220 12%
21/08/2020 VL - 39, Chlamydia Trachomatis
08/01/2021 CD4 240 13% CD4/CD8 0.4
03/03/2021 CD4 280 14% CD4/CD8 0.3 VL<40

Offline daveR

  • Member
  • Posts: 201
Re: Low CD4 and HepB vaccination
« Reply #7 on: January 12, 2021, 08:19:38 am »
DaveR, thank you for your reply, you get me a hope.
What were your CD4s when you eventually got a response? What were your CD4 during your unsuccessful attempts? As you can see, my CD4s currently are 240, and they raise slowly.
As I mentioned above, I have to go to the other ID doc to get a 2nd opinion.

I was HIV negative on my failed attempts so CD4 count would have been normal. When I received the latest Jab my CD4 count was around 700. My ID Doctor put it down to the newer vaccine, compared to the earlier types I had received. Unfortunately I did not take note of any of the names. She just said she wanted to try a single booster injection to see if it worked, and it did.

Offline multifan

  • Member
  • Posts: 14
Re: Low CD4 and HepB vaccination
« Reply #8 on: January 12, 2021, 02:48:01 pm »
BHIVA recommends HBV vaccination especially to people who are at risk with suppressed HIV-1 RNA. They recommend that even CD4 count is <350 with doubled dose (Engerix B/HBvaxPRO 40g or Fendrix 20g). HBV vaccine is not replicating, so it is safe even for those with CD4 count <200.
https://www.bhiva.org/file/NriBJHDVKGwzZ/2015-Vaccination-Guidelines.pdf

I think getting a 2nd opinion is mandatory in my case.
OI - CNS Toxoplasmosis, oral candidiasis
17/05/2018  CD4 - 27  VL 188.000 Dexamethasone i.v., Sulfadiazine 2x3g, Daraprim 75mg, Leucovorin 15mg 1xd, Azithromycinum 1xweek 600mg
31/05/2018  start Triumeq
21/06/2018  discharge from hospital
08/07/2018  CD4 - 124  VL 37 Sulfadiazine 1.5g2xd, Daraprim 50mg 1xd, discontinue Azithromycinum
14/08/2018  CD4 - 110 11%
10/10/2018  CD4 -  94  9% 
16/10/2018  CD4 - 154 VL <20
16/11/2018  CD4 - 180 VL<20
20/01/2019 CD4 140 VL<20
29/06/2019 CD4 220 VL <20 13%
29/08/2019 CD4 180  13%
25/09/2019 CD4 220  14%  CD4/CD8 0.31 discontinued Daraprim/Sulfadiazine
18/05/2020 CD4 220 12%
21/08/2020 VL - 39, Chlamydia Trachomatis
08/01/2021 CD4 240 13% CD4/CD8 0.4
03/03/2021 CD4 280 14% CD4/CD8 0.3 VL<40

 


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