Viremic controllers were characterized by a lesser degree of virologic control, defined as 3 VLs 2000 copies/mL over a period of 12 months in the absence of HAART

Viremic controllers were characterized by a lesser degree of virologic control, defined as 3 VLs 2000 copies/mL over a period of 12 months in the absence of HAART. HIC (n?=?143) and non-controllers (n?=?1566) with documented anti-HBs regardless of the timing of HBV vaccination. Positive vaccine responses were more common in HIC (65.9%) compared to HAART-na?ve non-controllers (36.6%; P 0.001), but much like non-controllers on HAART (59.9%; P?=?0.549). Factors associated with vaccine response for HIC compared to HAART-na?ve non-controllers include HIC status (OR 2.65, 95% CI 1.23C5.89; P?=?0.014), CD4 count at last vaccination (OR 1.28, 1.15C1.45 for every 100 cells/uL; P 0.001), and quantity of vaccine doses administered (OR 0.56, 0.35C0.88; P?=?0.011). When HIC were compared to non-controllers on HAART, only CD4 count at last vaccination was significant (OR 1.23, 1.1C1.38 for every 100 cells/uL; P 0.001). The rate of AIDS or death per 100 person/years for HIC compared to non-controllers was 0.14 (95% CI 0C0.76) versus AG-120 0.98 (95% CI 0.74C1.28) for vaccine responders and 0 (95% CI 0C2.22) versus 4.11 (95% CI 3.38C4.96) for non-responders, respectively. Conclusions HIC have improved HBV vaccine responsiveness compared to treatment-na?ve non-controllers, but much like those on AG-120 VL-suppressive HAART. Progression to AIDS or death can be predicted by HBV vaccine responder status for non-controllers, however these events are rarely observed in HIC. Introduction Elite and viremic controllers, collectively termed HIV controllers (HIC), are an uncommon subgroup of HIV-infected individuals with the ability to naturally suppress plasma viral weight (VL) in the absence of highly active antiretroviral therapy (HAART). Elite controllers typically suppress VL below the limit of detection of clinical assays while viremic controllers exhibit a lesser degree of virologic control with low level viremia. Elite and viremic controllers comprise 1% and approximately 3% of persons HDAC3 in most HIV cohorts, respectively [1]C[3]. Although defined by virologic criteria, HIC status is typically associated with improved clinical outcomes comparable to individuals on VL-suppressive HAART, including higher CD4 counts and reduced risk of developing AIDS and death [1], [4]C[6]. To determine the mechanisms responsible for spontaneous virologic control, HIC are intensely analyzed with the anticipation of developing novel treatment strategies and possibly a therapeutic vaccine for the treatment AG-120 of HIV. One aspect of HIC that has not been sufficiently analyzed is usually immune response to vaccinations. Since HIC status is associated with more favorable functional immunity, enhanced responses to vaccinations may be expected. The hepatitis B computer virus (HBV) vaccine has several advantages for studying vaccine response in HIV-infected persons. In contrast to some other vaccines, such as the pneumococcal polysaccharide vaccine which is a T-cell impartial antigen, AG-120 HBV vaccine may provide a more total assessment of B-cell and T-cell function. A positive response to HBV vaccination requires T-cell processing, but also other aspects of immune function including antigen presentation of the peptide-based vaccine and B-cell activity [7]C[10]. HBV vaccination is also recommended for all those HIV-infected individuals without prior immunity and serologic response can be routinely assessed by antibody detection (anti-HBs)[11]. Finally, HBV vaccine has prognostic value in the setting of HIV contamination as vaccine responders have been shown to have a reduced risk of developing AIDS and death, including those with CD4 counts 500 cells/uL [12]. HIV-infected patients have diminished responsiveness to HBV vaccination, ranging from 20C62% compared to 90% in HIV-uninfected persons [13]C[15]. Despite the diminished response rates, there are several HIV disease-related factors associated with improved HBV vaccine responses, including CD4 cell count 350 cells/uL and use of effective HAART resulting in VL suppression and subsequent immune reconstitution [13], [16], [17]. HIC typically possess many of these factors in the.