In Reply: Our study showed that, in adults with HIV-1, both the IM40 × 4 regimen and the ID4 × 4 regimen improved serological response compared with the standard IM20 × 3 regimen. The rate of systemic reactions was similar in the 3 groups; however, patients in the IM40 × 4 group experienced higher rates of fever, nausea, or edema, and patients in the ID4 × 4 group experienced a higher rate of local adverse reactions (except pain, which was less frequent) than did patients in the IM20 × 3 group. Dr Bélec and colleagues suggest that the higher rates of fever and nausea more frequently experienced in the IM40 × 4 group may be due to dose-related effects of the aluminum adjuvant included in the vaccine.
Launay O, Carrat F. Safety and Immunogenicity of Hepatitis B Vaccine Regimens in Adults With HIV-1—Reply. JAMA. 2011;306(2):156-157. doi:10.1001/jama.2011.944