Impaired humoral immune response to hepatitis B vaccination in children with HIV and type 1 diabetes mellitus

Abstract

Hepatitis B virus (HBV) infection is a major public health issue globally. The control of HBV infection has seen remarkable progress through vaccination. The HBV vaccine stimulates the production of protective anti-HBs antibodies at a level of at least 10 mIU/mL. Various factors, such as infectious and non-infectious diseases, can impact the immune response to the HBV vaccine. Therefore, this study aimed to evaluate the humoral immune response to the HBV vaccine in children with HIV and insulin-dependent diabetes mellitus (IDDM) at Ayder Comprehensive Specialized Hospital, Tigray, northern Ethiopia. A case-control study was conducted from May 2 to July 28, 2019, at Ayder Comprehensive Specialized Hospital. Ninety children were enrolled (30 with HIV, 30 with IDDM, and 30 healthy controls) using a convenience sampling technique. A five ml blood sample was collected for quantification of anti-HBs antibodies using MAGLUMI 800. The data was entered into EPI data version 4.6 and then exported to GraphPad Prism Version 10.4.0 for analysis. A one-way ANOVA was used to compare mean anti-HBs titers. Logistic regression models were used to assess factors associated with protective (anti-HBs ≥ 10 mIU/mL) versus non-protective responses. A P-value ≤ 0.05 at a 95% confidence interval was considered statistically significant. The study included a total of 90 children, with 30 children in each group (HIV, IDDM, and healthy controls), with mean ages of 6.22 ± 3.03, 6.16 ± 2.56, and 6.37 ± 2.78 years, respectively. Children with HIV and IDDM had significantly lower Anti-HBs titers compared to healthy controls, with means ± SD of 291.16 ± 362.8 versus 551.3 ± 431.5 (p = 0.014) and 276.33 ± 338.63 versus 551.3 ± 431.5 (p = 0.008), respectively. A significant mean difference was observed among the control, HIV, and IDDM groups (p = 0.009). In children with HIV and IDDM, the age group ≤ 5 years and time elapsed from vaccination of < 7 years were significantly associated with diminished anti-HBs response. A reduced anti-HBs antibody response following HBV vaccination was observed in children with HIV infection and IDDM. Notably, younger age (≤ 5 years) and shorter time since vaccination (< 7 years) were independently associated with diminished antibody responses. Therefore, it is crucial to conduct regular follow-up assessments of antibody levels and implement large-scale investigations for improved monitoring and control.