Hepatitis B vaccine: a seven-year study of adherence to the immunization guidelines and efficacy in HIV-1-positive adults

SummaryBackgroundVaccination against hepatitis B virus (HBV) has been recommended for all high-risk adults since 1982. Since the advent of highly active antiretroviral therapy, few studies have examined adherence to the Infectious Diseases Society of America (IDSA) and Advisory Committee on Immunization Practices (ACIP) guidelines for hepatitis B vaccination in persons infected with HIV.MethodsThis was a seven-year retrospective, cross-sectional analysis of HBV vaccination practices in HIV-1-positive adults treated in an urban ambulatory care center. Compliance with screening, hepatitis B vaccination recommendations, and response to vaccination were assessed.ResultsOf the 1601 charts reviewed, 717 persons were eligible for vaccination against hepatitis B. Of these patients, 503 received at least one dose of vaccine, but only 356 patients completed the three-dose series. Vaccine response was associated with CD4 count (p = 0.006) and viral load (p = 0.001) at the time of the first dose. However, development of hepatitis B surface antibody was seen at all CD4 counts and viral loads. The multivariate analysis showed only the HIV viral load was predictive of immunologic response. Twenty of the vaccine-eligible patients who did not receive vaccination were infected with HBV during the study period. No vaccinated persons contracted hepatitis B.ConclusionFailure to implement these guidelines represents a missed opportunity to prevent disease. In our study, HIV viral load was better than CD4 count as a predictor of response to the HBV vaccination. However, neither low CD4 count nor high HIV viral load should be used as justification to delay vaccination of high-risk persons.