Hepatitis B Surface Antibody Clearance After Vaccination in People With HIV.

Background: People with HIV (PWH) are at higher risk of developing chronic hepatitis B, and therefore vaccination against HBV is highly recommended. Clearance of hepatitis B surface antibody (anti-HBs) over time is poorly described in PWH. Methods: We retrospectively included vaccinated PWH with anti-HBs ≥10 IU/L from the French Dat'AIDS database. Those with a cured hepatitis B were excluded. For each participant, all anti-HBs levels were collected until March 2024. Anti-HBs peak was defined as the highest anti-HBs value and corresponded to entry into the analysis. Factors associated with anti-HBs clearance below 10 IU/L were identified using a multivariable Cox model. Results: 11 082 PWH were included, 4480 had peak anti-HBs levels between 10 and 99 IU/L, 3268 between 100 and 499 IU/L, 1205 between 500 and 999 IU/L, and 2129 ≥ 1000 IU/L. Median follow-up was 3.8 [1.6, 7.1] years. Antibody clearance over time was similar in the three groups with peak anti-HBs ≥100 IU/L, and significantly slower than in the group with anti-HBs <100 IU/L. Peak anti-HBs level was the variable with the greatest impact on anti-HBs clearance in the multivariable analysis. Compared with participants with anti-HBs <100 IU/L, having peak anti-HBs values of 100-499 IU/L, 500-999 IU/L and ≥1000 IU/L were protective factors for anti-HBs clearance, with hazard ratios of .26 [0.23, 0.30], 0.17 [0.13, 0.22] and 0.10 [0.07, 0.12], respectively, P < .001. Conclusions: Peak anti-HBs level is the key factor of antibody persistence in PWH. Those with anti-HBs levels below 100 IU/L should be monitored closely and considered for a booster dose.