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To assess the antibody response to hepatitis B immunization in HIV-infected and uninfected infants.Cohort, comparing hepatitis B surface-antibody responses of HIV-infected infants with HIV-exposed but uninfected infants.Urban children's hospital outpatient clinic for families with HIV-infected members.All infants received hepatitis B vaccine according to the American Academy of Pediatrics and Centers for Disease Control and Prevention recommended schedule.Forty-one HIV-exposed or infected infants were immunized with hepatitis B vaccine in the first year of life. Twenty-two out of 24 (92%) HIV-exposed but uninfected infants demonstrated an antibody response to hepatitis B immunization, compared with six out of 17 (35%) HIV-infected infants (P<0.0005). CD4 percentage and CD4 counts were significantly lower in the HIV-infected infants than in the uninfected infants, but there was no significant difference in CD4 count or percentage between HIV- infected responders and nonresponders.The humoral immune response to hepatitis B immunization, administered before 12 months of age, is significantly reduced in HIV-infected children and is independent of CD4 count. Given the large number of infants born each year to pregnant women coinfected with HIV and hepatitis B, further studies to assess the efficacy of increased doses of antigen and variations in the dosage schedule are urgently needed.