More than a third of patients with HIV infection fail to get hepatitis B virus (HBV) vaccination, despite a longstanding recommendation, report researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta.

Liver-related deaths among HIV patients, in which hepatitis B plays a central role, account for the largest proportion of deaths not related to AIDS. In 2016, the World Health Organization (WHO) resolved to eliminate HBV infection as a public health threat by 2030,” Dr. John Weiser from the CDC's Division of HIV/AIDS Prevention note in an article online in Annals of Internal Medicine.

“Meeting goals for hepatitis B elimination will require increased vaccination of HIV patients in all practice settings, particularly at facilities not funded by the Ryan White HIV/AIDS Program (RWHAP),” they say.

The CDC team estimated the prevalence of HBV vaccination in a nationally representative sample of more than 18,000 adults receiving HIV care between 2009 and 2012.

All were participants in the Medical Monitoring Project, a surveillance system that produces annual nationally representative, cross-sectional estimates of behavioral and clinical characteristics of HIV-infected adults in the United States.

At the beginning of the surveillance period, 44.2% had no documentation of HBV vaccination, immunity, or infection in the medical record and were classified as candidates to initiate vaccination, they found.

During the surveillance period, 9.5% of candidates actually got the vaccine despite ongoing HIV care. In addition, 7.5% of vaccine candidates were not vaccinated but had new documentation of hepatitis B immunity or infection, and 82.9% were not vaccinated and had no new documentation of immunity or infection. At the end of the surveillance period, 36.7% of HIV-infected patients remained candidates to initiate HBV vaccination.

HBV vaccination rates were significantly higher among patients receiving care at RWHAP-funded than non-RWHAP-funded centers (12.5% vs. 3.7%), and those receiving care at non-private versus private facilities (11.8% vs. 5.6%).

Patients were more likely to receive HBV vaccination if they had income below the poverty level, had low educational attainment, were African-American, younger and recently homeless, and had low CD4-cell counts.

Federal guidelines recommend vaccinating all patients with HIV during their first visit, immediately after drawing blood for serologic testing, and not deferring vaccination of patients presenting with a low CD4-cell count,” the CDC researchers note.

“Meeting goals for hepatitis B elimination will require a multifaceted approach to increasing vaccination of HIV patients. 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,” they conclude.