How to Reduce Hepatitis B and HIV Co-infections

Reducing the number of hepatitis B virus cases seems simple since vaccines have been available for many years.

And people with HIV who are co-infected with hepatitis B are at increased risk for serious, life-threatening complications.

Which means, anyone living with HIV should be tested for hepatitis B, but they aren’t, reports health officials.

According to the Centers for Disease Control and Prevention (CDC), approximately 10 percent of people living with HIV also have hepatitis B (HBV).

A new study found that healthcare providers are missing opportunities to address this co-infection population.

These researchers found 30 percent of HIV patients had missed opportunities to initiate hepatitis B vaccination.

This study included 18,089 adults receiving HIV medical care during 2009 to 2012.

At the beginning of the study, 44.2% of HIV patients were candidates for hepatitis B vaccination.

By the end of this study’s surveillance period, 9.6% of candidates were vaccinated, 7.5% had no documented vaccination.

And 82.9% of HIV patients remained HBV vaccination candidates.

Most persons who are at risk for, are susceptible to or have HBV infection are not screened, vaccinated, or linked to care, according to the CDC.

Although the CDC has issued clinical guidelines, their HBV implementation recommendations have been sub-optimal.

The main risk factors for both HIV and hepatitis B co-infection are the same: unprotected sex and injection drug use.

In the United States, an estimated 847,000 persons are living with chronic hepatitis B virus infection, and approximately 14,000 deaths are attributable to it each year.

About 2 of every 3 persons with chronic HBV infection are unaware of their infection, says the CDC.

Approximately 70 percent of persons with chronic HBV infection in the United States are foreign-born, and the prevalence among foreign-born persons is 3 to 5 percent, compared with 0.3 percent in the general population.

Meeting the CDC’s goals for hepatitis B elimination will require increased vaccination of HIV patients in all practice settings,

During June 2017, the CDC updated its ‘Best Practice Advice’ for clinicians saying ‘Clinicians should vaccinate against chronic hepatitis B virus (HBV) in all unvaccinated adults at risk for infection.’

These persons should receive postvaccination testing and those with suboptimal response (antibody to HBsAg level <10 mIU/mL) should be revaccinated.

The CDC vaccination schedule most often used for children and adults is 3 intramuscular injections, the second and third doses administered 1 and 6 months, after the first dose.

Higher dosages may be required for immunocompromised persons and those with end-stage renal disease.

Two single-antigen vaccines and two combination vaccines are currently licensed in the United States:

Single-antigen hepatitis B vaccines:

• ENGERIX-B
• RECOMBIVAX HB

Combination vaccines:

• PEDIARIX: Combined hepatitis B, diphtheria, tetanus, acellular pertussis (DTaP), and inactivated poliovirus (IPV) vaccine. Cannot be administered before age 6 weeks or after age 7 years.
• TWINRIX: Combined Hepatitis A and hepatitis B vaccine. Recommended for persons aged ≥18 years who are at increased risk for both Hepatitis A virus and HBV infections.

The CDC Vaccine Price List provides the private sector hepatitis vaccine prices for general information, and vaccine discounts can be found here.

Vaccines, like any medicine, can have side effects, says the CDC. You are encouraged to report negative side effects of vaccines to the FDA or CDC.

The Primary Funding Source for this research was Centers for Disease Control and Prevention, and the Financial support for the development of this paper comes exclusively from the ACP operating budget.

This paper, written by Winston E. Abara, MD, PhD; Amir Qaseem, MD, PhD, MHA; Sarah Schillie, MD, MPH, MBA; Brian J. McMahon, MD; and Aaron M. Harris, MD, MPH, was developed for the High Value Care Task Force of the American College of Physicians and the CDC.