Does increased hepatitis B vaccination dose lead to a better immune response in HIV-infected patients than standard dose vaccination: a meta-analysis?

Human immunodeficiency virus (HIV)-infected patients often fail to produce protective antibodies to hepatitis B virus (HBV) vaccine. Some reports have suggested that increased-dose vaccination improves immune response to HBV vaccine in HIV-infected patients. To assess the efficacy of increased-dose HBV vaccination in HIV-infected patients, a systematic review of the literature and meta-analysis of clinical trials was conducted. We only included trials that compared the response rate at completion of HBV vaccine schedules in patients who had increased-dose HBV vaccine courses with controls (standard-dose HBV vaccine vaccination schedule). The fixed-effects model, with heterogeneity and sensitivity analyses, was used in this study. We identified five studies involving 883 HIV-positive vaccine recipients. Pooling of study results showed a significant increase in response rates among high-dose patients versus control patients; the pooled odds ratio (OR) was 1.96 (95% confidence interval [CI]: 1.47; 2.61). Four out of five identified studies included only vaccine-naive patients. The overall OR was 1.82 (95% CI: 1.35-2.47). No study heterogeneity was found. Our meta-analysis showed that increasing the dosage of vaccine may significantly improve immune responses in HIV-infected patients.