Over one-third of U.S. HIV patients are not vaccinated against hepatitis B

1. One third of HIV patients in the United States (U.S.) remain unvaccinated against hepatitis B.

2. Of HIV patients who were candidates for hepatitis B vaccination, only 1 in 10 were vaccinated within 1 year of continuing care for HIV.

Evidence Rating Level: 3 (Average)

Study Rundown: In comparison to the general population, individuals infected with HIV have a higher risk of hepatitis B virus (HBV) infection.  Over two decades ago, the Advisory Committee on Immunization Practices recommended that all individuals with HIV be vaccinated for hepatitis B.  In 2016, the World Health Organization set the goal of removing HBV infection as a danger to public health by 2030.  To estimate hepatitis B vaccination prevalence among HIV patients in the U.S., researchers conducted a nationally representative cross-sectional survey.  The authors studied 18 089 adult recipients of HIV medical care who were also participants in the Medical Monitoring Project (MMP) during 2009 to 2012.  The researchers found that over one third of HIV patients in the U.S. remain unvaccinated against hepatitis B.  Of these patients, only 1 in 10 were vaccinated within 1 year of continuing care for HIV.  The authors suggested that in order to reach goals regarding reduction of HBV infection, vaccination rates of HIV patients must be increased, especially at private practices and facilities that lack Ryan White HIV/AIDS Program (RWHAP) funding.

A strength of the study is that it aids in filling the knowledge gap regarding the prevalence of hepatitis B vaccination in the HIV patient population.  A limitation of the study is that it does not include information regarding vaccine series completion or the prevalence of actual immunity.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Hepatitis B vaccination and risk of hepatitis B infection in HIV-infected individuals

In-Depth [cross-sectional study]: In this study, researchers surveyed 18 089 adult recipients of HIV medical care who were also participants in the MMP during 2009 to 2012.  The MMP was designed to yield nationally representative data that included clinical and behavioral characteristics of U.S. adults infected with HIV.  Researchers measured the prevalence of candidates to start hepatitis B vaccination, which was determined by the lack of documented hepatitis B vaccination or lab evidence of infection or immunity.  Researchers also measured the prevalence of starting vaccination among such candidates, which was defined by documentation of ≥1 vaccine dose during a 12-month surveillance period that included continuing medical care for HIV.  At the start of surveillance, 44.2% of HIV patients were candidates to start vaccination.  By the close of surveillance, 9.6% of candidates were vaccinated, 7.5% had no documentation of vaccination but had documentation of immunity or infection, and 82.9% stayed candidates.  During the surveillance period, 12.5% of HIV patients at facilities with RWHAP funding were vaccinated compared to 3.7% of patients at facilities without RWHAP funding.  At the close of the study, 36.7% of HIV patients were candidates to start vaccination.

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