Providers Urged to Recommend This Vaccine for HIV-Positive Patients

SAN DIEGO, CA—Due to several potential barriers, the rates of completion for the human papillomavirus (HPV) vaccine series are lower among HIV-positive patients and men at Denver Health, a large urban public healthcare system, researchers reported at IDWeek 2015.

“HIV-positive patients are less likely to receive HPV vaccine,” reported Grace E. Marx, MD, MPH, at Infectious Disease, the University of Colorado in Aurora, Colorado. “Providers of HIV-positive patients may not recommend the HPV vaccine due to misperceptions [regarding] lack of efficacy and safety.”

Most cervical and anal cancers and “a substantial percentage of head and neck cancers” are caused by HPV, Dr. Marx noted. In addition, “HPV-related disease is known to be more prevalent and aggressive in persons with HIV co-infection.” But multiple barriers remain to HPV vaccination at HIV clinics, Dr. Marx reported.

A survey of 32 clinicians found that half of providers who consider themselves primary caregivers for HIV patients, do not routinely assess their patients' HPV vaccination status, Dr. Marx reported. The survey also revealed that HPV vaccine “is not as available in HIV clinics as other recommended adult vaccines,” she added.

Most HIV care providers surveyed at Denver Health believe the HPV to be less effective in HIV-positive patients, particularly for patients with lower CD4 counts, she noted.

The survey of providers identified potential barriers to recommending HPV vaccine to HIV-positive patients, including lack of adequate HPV vaccination reimbursement, HPV vaccine unavailability at the HIV clinic, and difficulty ensuring patients will complete the 3-dose series.

To evaluate HPV vaccine coverage at Denver Health, Dr. Marx and colleagues assembled two retrospective dynamic cohorts of HIV-positive (n=304) or HIV-negative (n=54,298) adults who had visited a primary care clinic twice within an 18-month period between 2006 and 2014 while age-eligible for the HPV vaccine, based on national guidelines. Four clinics were included in the study.

Vaccination records were compiled from the electronic medical record and the state-wide vaccination registry, Dr. Marx reported.

Results showed that HPV vaccination rates were low in both cohorts: 2.3% of the HIV-positive and 13.2% of the HIV-negative adults had completed the 3-dose vaccine series, with vaccination rates increasing with each calendar year.

Among the HIV-positive patients, 10 of 36 (27.8%) females initiated the HPV vaccine series and 1 (2.8%) completed it. Among males, 17 of 268 (6.3%) initiated the series and 6 (2.2%) completed it.

For the HIV-negative patients, 10,749 of 34,662 (31.0%) females initiated the HPV vaccine series and 6,194 (17.9%) completed it. Among males, 2,464 of 19,636 (12.5%) initiated the series and 965 (4.9%) completed it.

“HIV infection (P<0.001) and male gender (P=0.03) were significantly associated with lower rates of HPV vaccine series completion,” Dr. Marx noted. “A tailored approach is needed to increase provider engagement to strongly recommend the HPV vaccine and enhance patient vaccine awareness.”  


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