Nouman Shafique, MD1, Magda Elamin, MD2, Prachi Mann, MD3, Tareq Alsaleh, MD3, Abdullah Javed, MBBS4, Nihal I. Khan, MD1, Amna Malik, MD5, Sobaan Taj, MD5, Adeena Shafique, MBBS6, Ali Haider, MBBS7, Iqra Shafique, MBBS8, Osama Ijaz, MD9, Syed Hamaad Rahman, DO10, Abu Hurairah, MD5, Babu P. Mohan, MD11 1AdventHealth Orlando, Orlando, FL; 2Department of Internal Medicine, AdventHealth Orlando, Orlando, FL; 3Department of Internal Medicine, Adventhealth Orlando, Orlando, FL; 4Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 5AdventHealth, Orlando, FL; 6Aga Khan University, Karachi, Sindh, Pakistan; 7Nishtar Medical University, Multan, Multan, Punjab, Pakistan; 8CMH Institute of Medical Sciences, Bahawalpur, Punjab, Pakistan; 9SSM Health St. Mary's Hospital - St. Louis, Richmond Heights, MO; 10Methodist Dallas Medical Center, Dallas, TX; 11Orlando Gastroenterology PA, Orlando, FL Introduction: Patients with HIV are at increased risk of hepatitis B virus (HBV) infection and often show suboptimal response to conventional HBV vaccines. HepB-alum, an aluminum-adjuvanted vaccine, has been widely used but demonstrates limited immunogenicity in immunocompromised hosts. HepB-CpG, which incorporates a Toll-like receptor 9 agonist (CpG 1018) as an adjuvant, has shown superior immunogenicity in the general population and is now being explored in PWH. We conducted a meta-analysis comparing seroprotection rates between HepB-CpG and HepB-alum vaccines in patients with HIV, as well as evaluating factors associated with seroconversion. Methods: A systematic review of MEDLINE, EMBASE, and scopus through May 2025 identified studies comparing seroconversion outcomes between HepB-CpG and HepB-alum in adults with HIV. Two studies met inclusion criteria: one phase 3 randomized trial and one retrospective observational cohort. The primary outcome was the pooled odds ratio (OR) of seroconversion between the two vaccine types. Secondary analysis examined demographic and clinical factors associated with successful seroconversion. Pooled ORs were calculated using a random-effects model. Results: Our meta-analysis included 459 participants (224 HepB-alum; 235 HepB-CpG). The pooled odds of achieving seroprotection ( defined as HBsAb ≥10 IU/L) were significantly higher with HepB-CpG compared to HepB-alum (OR 5.34; 95% CI: 1.71–16.65; p=0.004), with moderate heterogeneity (I² = 66%). In subgroup analysis, absence of diabetes was associated with higher seroconversion (84.1%), while rates were comparable in participants with chronic kidney disease, prior use of steroids or biologics. Seroprotection was also consistent across sexes, with 80.8% of males and 87.1% of females achieving response. Discussion: HepB-CpG offers significantly improved seroprotection over HepB-alum in people with HIV. Clinical factors such as diabetes may impact vaccine responsiveness, but seroconversion remains high across other subgroups including those with CKD or prior immunosuppressive therapy. Given the enhanced efficacy and comparable safety profile, HepB-CpG should be strongly considered in vaccination strategies for persons with HIV. Larger prospective studies are needed to confirm these findings and inform vaccine policy.
Figure: Figure 1 showing the baseline characteristics of studies including and pooled OR comparing seroconversion rates
Figure: Factors associate with seroconversion
Disclosures: Nouman Shafique indicated no relevant financial relationships. Magda Elamin indicated no relevant financial relationships. Prachi Mann indicated no relevant financial relationships. Tareq Alsaleh indicated no relevant financial relationships. Abdullah Javed indicated no relevant financial relationships. Nihal Khan indicated no relevant financial relationships. Amna Malik indicated no relevant financial relationships. Sobaan Taj indicated no relevant financial relationships. Adeena Shafique indicated no relevant financial relationships. Ali Haider indicated no relevant financial relationships. Iqra Shafique indicated no relevant financial relationships. Osama Ijaz indicated no relevant financial relationships. Syed Hamaad Rahman indicated no relevant financial relationships. Abu Hurairah indicated no relevant financial relationships. Babu Mohan indicated no relevant financial relationships.
Nouman Shafique, MD1, Magda Elamin, MD2, Prachi Mann, MD3, Tareq Alsaleh, MD3, Abdullah Javed, MBBS4, Nihal I. Khan, MD1, Amna Malik, MD5, Sobaan Taj, MD5, Adeena Shafique, MBBS6, Ali Haider, MBBS7, Iqra Shafique, MBBS8, Osama Ijaz, MD9, Syed Hamaad Rahman, DO10, Abu Hurairah, MD5, Babu P. Mohan, MD11. P3752 - Seroprotection of Hepb-Alum vs Hepb-Cpg Vaccines in People With HIV: A Meta-Analysis and Systematic Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
