Chaiklang et al conducted a randomized trial in Thailand, in 132 HIV+ adults who were HBV– and had CD4 cell count of >200 cells/μL and undetectable viral load of 3 different hepatitis B vaccine schedules.

Patients were 1:1:1 randomly assigned to receive a standard vaccination (20 μg intramuscularly at month 0, 1, and 6 or 20 μg IM at month 0, 1, 2, and 6 or 40 μg IM at month 0, 1, 2, and 6. .Responders were patients who had hepatitis B surface antibody (anti-HBs) of at least 10 mIU/mL) at month 7.

The percentage of responders at month 7 was 88.6 in the IM 20x3 group, 93.2 in the IM 20x4 group (p = 0.458 vs IM 20x3 group), and 95.5% in the IM 40x4 group (p = 0.237 vs IM 20x3 group).

The standard HBV vaccination in HIV+ adults with CD4 cell counts >200 cells/μL and undetectable viral load is highly effective. Regimens of 4 injections of either standard or double doses may increase the response rate and induce higher level of protective antibody.