More Than One-Third of Patients With HIV Did Not Receive HBV Vaccination

More than one-third of HIV patients in the United States did not receive the hepatitis B vaccination from 2009 to 2012, despite being more susceptible to the hepatitis B virus (HBV), according to a study published in Annals of Internal Medicine.

In 2016, the World Health Organization announced its effort to eradicate the HBV infection as a public health threat by 2030. The following year, the National Academies of Sciences, Engineering, and Medicine put forth a plan to achieving the goal in the United States, and HHS' National Viral Hepatitis Action Plan outlined strategies for achieving a 60% reduction in new HBV cases by 2020.

“The plan establishes indicators for measuring progress toward universal vaccination of vulnerable adults, including persons with HIV,” wrote the authors. "However, there are currently no nationally representative estimates of the percentage of HIV patients who are not vaccinated for hepatitis B against which progress can be measured.”

The authors utilized the Medical Monitoring Project (MMP), a surveillance system designed to produce nationally representative, annual, cross-sectional estimates of characteristics of people with HIV in the US. From 2009 to 2012, the MMP used a 3-stage, probability-proportional-to-size sampling design; states and territories, facilities providing outpatient HIV clinical care in those jurisdictions, and HIV-infected adults receiving care at the facilities were sampled.

Primary outcomes were:

• No documentation of hepatitis B vaccination or laboratory evidence of immunity or infection (candidates to initiate vaccination)
• Initiation of vaccination among candidates, defined as documentation of at least 1 vaccine dose in a 1-year surveillance period during which patients received ongoing HIV care

The analysis included 18,089 participants. Of the participants, 44.2% had no documentation of vaccination, immunity, or infection at the beginning of the surveillance period and were classified as candidates to initiate vaccination. By the end of the surveillance period, 9.6% of the candidates were vaccinated, 7.5% had no documented vaccination but had documented infection or immunity, and 82.9% remained candidates.

Three-fourths of the candidates were prescribed antiretroviral agents, which were dually active against HBV. At the end of the surveillance period, 36.7% remained candidates to initiate vaccination.

Among the participants at facilities funded by the Ryan White HIV/AIDS Program (RWHAP), 12.5% were vaccinated during the surveillance period versus 3.7% of participants at facilities not funded by RWHAP.

“Meeting goals for hepatitis B elimination will require a multifaceted approach to increasing vaccination of HIV patients,” wrote the authors. “Particular attention should be focused on increasing vaccination of patients who receive care in private practices or at facilities that are not funded by RWHAP.”

Reference

Weiser J, Perez A, Bradley H, et al. Low prevalence of hepatitis B vaccination among patients receiving medical care for HIV infection in the United States, 2009 to 2012. Ann Intern Med. [Epub ahead of print December 26, 2017] doi: 10.7326/M17-1689.