Background: Understanding immune responses after HBV vaccination is important to prevent HBV infection in PLWH and to achieve successful treatment. Methods: Thirty-two PLWHs with CD4⁺ cell count > 350 cells/µL and HIV RNA < 200 copies/mL were vaccinated with 20 µg of HBV vaccine at weeks 0, 4, and 24 in this prospective study. We measured total HIV DNA levels, HBsAb titers and HBsAg-specific T-cell responses during follow-up time. Results: All patients achieved protective HBsAb titer after immunization. The magnitude of the IFN-r and TNF-a response to HBsAg was 22.0 (IQR: 6.5–65.0) and 106.50 (IQR: 58.5–203.0) spot-forming cells (SFC)/10⁵ PBMC, respectively at week 0. The level of IFN-r secreted at weeks 12 and weeks 36 to 48 was comparable with that at week 0. However, IFN-r response was higher at weeks 12 than that at weeks 36 to 48 (p = 0.02). The level of TNF-a secreted at weeks 12 was higher than that at week 0 (p < 0.001). Total HIV DNA levels were 2.76 (IQR: 2.47–3.07), 2.77 (IQR: 2.50–3.09), 2.77 (IQR: 2.41–2.89) log₁₀ copies/10⁶ PBMCs at weeks 0, 12, 36 to 48, respectively. No correlation was observed between IFN-r and TNF-a levels and HBsAb titer as well as total HIV DNA levels after immunization. Conclusion: Humoral immunity was satisfactory, but cellular immunity and decline in HIV reservoir were not optimal after HBV vaccine immunization in these patients.

Background: Fever of unknown origin (FUO) is clinically challenging in the setting of myelodysplastic syndrome (MDS). This study aimed to describe the clinical and laboratory features of patients with MDS and FUO and to explore factors associated with in-hospital fever resolution. Methods: We conducted a retrospective, single-center observational study of hospitalized patients with MDS and FUO at Peking Union Medical College Hospital, China, between January 2013 and December 2022. Patients were categorized into treatment-responsive and treatment-unresponsive groups based on fever outcomes after treatment. Demographic, clinical and laboratory features were collected and compared between the two groups. Results: A total of 98 patients were screened and 89 were included in the study. In approximately 80% of patients, FUO presented as the initial manifestation of MDS. Over half of the patients had high or very high risk per the revised International Prognostic Scoring System (IPSS-R), and complex karyotypes were observed in 25.8% of patients. MDS subtype distribution differed significantly between the groups (p = 0.027). Lower-blast MDS (MDS-LB) was more common in the treatment-responsive group (70.3% vs. 48.1%), whereas increased-blast MDS (MDS-IB) was more frequent in the treatment-unresponsive group (16.2% vs. 42.3%). Mucocutaneous lesions were more frequent among treatment-responsive patients (54.1% vs. 21.2%; p = 0.002). A higher percentage of CD8+CD38+ T-cells was associated with favorable treatment response (66.7 [60.4,80.6] vs. 47.4 [38.5,57.7]; p = 0.003). In addition, use of glucocorticoids and immunosuppressants was significantly associated with fever resolution (p = 0.004 and p = 0.043, respectively). Conclusions: In this selected cohort, MDS patients with FUO were predominantly at high risk and carried unfavorable prognostic factors. Mucocutaneous presentation and elevated CD8+CD38+ T-cell proportions were associated with in-hospital fever improvement. The association between anti-inflammatory treatment and fever resolution suggests a possible immune-mediated contribution to fever in these patients. As no non-MDS FUO comparison group was included and long-term outcomes were not available, these findings should be regarded as descriptive and hypothesis-generating.