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

[Guest guest]

International Journal of Infectious Diseases

Volume 12, Issue 6, November 2008, Pages e77-e83

Hepatitis B vaccine: a seven-year study of adherence to the immunization

guidelines and efficacy in HIV-1-positive adults

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

L. a, a and Sands, a,

aDivision of Infectious Diseases, University of Florida Health Science Center,

ville, Florida 32206, USA

Received 14 February 2008; revised 6 May 2008; accepted 19 May 2008.

Corresponding Editor: Mark Holodniy, California, USA. Available online 23

August 2008.

Summary

Background

Vaccination 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.

Methods

This 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.

Results

Of 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.

Conclusion

Failure 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.

Corresponding author. Tel.: +1 904 253 1326; fax: +1 904 798 2784

[Guest guest]

International Journal of Infectious Diseases

Volume 12, Issue 6, November 2008, Pages e77-e83

Hepatitis B vaccine: a seven-year study of adherence to the immunization

guidelines and efficacy in HIV-1-positive adults

References and further reading may be available for this article. To view

references and further reading you must purchase this article.

L. a, a and Sands, a,

aDivision of Infectious Diseases, University of Florida Health Science Center,

ville, Florida 32206, USA

Received 14 February 2008; revised 6 May 2008; accepted 19 May 2008.

Corresponding Editor: Mark Holodniy, California, USA. Available online 23

August 2008.

Summary

Background

Vaccination 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.

Methods

This 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.

Results

Of 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.

Conclusion

Failure 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.

Corresponding author. Tel.: +1 904 253 1326; fax: +1 904 798 2784