Missed Chances for Hep A, B Vaccinations Could Harm HCV/HIV Co-Infected Patients
NEW ORLEANS, LA—Hepatitis A virus (HAV) and Hepatitis B virus (HBV) can worsen disease among patients with HIV/Hepatitis C Virus (HCV) co-infection, but these patients often are not vaccinated against HAV and HBV, found authors of a retrospective single-institution cohort study reported at IDWeek 2016.
“Missed opportunity for HAV vaccination was seen in more than half of the patients in our sample,” reported Madelyne Bean, PharmD, of the Department of Infectious Diseases, Medical University of South Carolina, Charleston, SC, and coauthors. "In contrast, fewer missed opportunities were seen for HBV vaccination."
"One factor that may have affected vaccination rates was the required six months needed to complete the vaccine series," Dr. Bean noted.
Dr. Bean and colleagues emphasized that there exists "room to improve" the quality of care of these patients via vaccination.
HAV and HBV infection can cause more severe disease in patients with HIV/HCV co-infection; therefore, HAV and HBV vaccination is recommended for these patients. Inactivated HAV and HBV vaccines are available and should be given to all co-infected patients unless serology confirms immunity, and completion of these vaccines should be recognized as an important measure of quality of care for patients with HIV, Dr. Bean argued.
After vaccination, immunologic response should be confirmed with serology.
The study team evaluated medical records for 49 patients with HCV/HIV co-infection first seen at a clinic between 2006 and 2012. Sixty-one percent were African American, 82% were male, 59% were uninsured, 69% had a history of illicit drug use, 53% had mental illness histories, and 33% had been imprisoned.
Eighteen (37%) were HAV antibody positive and 6 (12%) received the complete vaccine series; 17 cases (55%) represented "missed opportunities" to vaccinate against HAV and another 8 patients (26%) were not retained in care at 1 year, and were therefore lost to follow-up.
Twenty-eight (57%) patients were HBV antibody positive; 4 (24%) completed the vaccine series, 5 (29%) of patients represented missed opportunities to vaccinate, and another 8 patients (47%) were not retained in care at 1 year.