John Weiser, MD, MPH; Alejandro Perez, MPH; Heather Bradley, PhD; Hope King, PhD, MSPH; R. Luke Shouse, MD, MPH
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the CDC.
Acknowledgment: The authors thank the participating MMP patients, facilities, project areas, and Provider and Community Advisory Board members. They also acknowledge the contributions of Mark Freedman, Scott Holmberg, the Clinical Outcomes Team and the Behavioral and Clinical Surveillance Branch at the CDC, and the MMP 2009–2013 Study Group Members (www.cdc.gov/hiv/statistics/systems/mmp/resources.html#StudyGroupMembers).
Financial Support: Funding for the Medical Monitoring Project is provided by the Centers for Disease Control and Prevention.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1689.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available at www.cdc.gov/hiv/statistics/systems/mmp/resources.html. Statistical code: Available from Dr. Weiser (e-mail, firstname.lastname@example.org). Data set: Not publicly available.
Requests for Single Reprints: John Weiser, MD, MPH, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E46, Atlanta, GA 30329; e-mail, email@example.com.
Current Author Addresses: Drs. Weiser, Bradley, and Shouse and Mr. Perez: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E46, Atlanta, GA 30329.
Dr. King: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS G37, Atlanta, GA 30303.
Author Contributions: Conception and design: J. Weiser, A. Perez, H. Bradley, H. King, R.L. Shouse.
Analysis and interpretation of the data: J. Weiser, A. Perez, H. Bradley, H. King, R.L. Shouse.
Drafting of the article: J. Weiser, A. Perez, H. King.
Critical revision of the article for important intellectual content: A. Perez.
Final approval of the article: J. Weiser, A. Perez, H. Bradley, H. King, R.L. Shouse.
Statistical expertise: A. Perez, H. Bradley.
Administrative, technical, or logistic support: A. Perez.
Collection and assembly of data: J. Weiser, A. Perez, R.L. Shouse.
Persons with HIV infection are at increased risk for hepatitis B virus infection. In 2016, the World Health Organization resolved to eliminate hepatitis B as a public health threat by 2030.
To estimate the prevalence of hepatitis B vaccination among U.S. patients receiving medical care for HIV infection (“HIV patients”).
Nationally representative cross-sectional survey.
18 089 adults receiving HIV medical care who participated in the Medical Monitoring Project during 2009 to 2012.
Primary outcomes were prevalence of 1) no documentation of hepatitis B vaccination or laboratory evidence of immunity or infection (candidates to initiate vaccination), and 2) initiation of vaccination among candidates, defined as documentation of at least 1 vaccine dose in a 1-year surveillance period during which patients received ongoing HIV medical care.
At the beginning of the surveillance period, 44.2% (95% CI, 42.2% to 46.2%) of U.S. HIV patients were candidates to initiate vaccination. By the end of the surveillance period, 9.6% (CI, 8.4% to 10.8%) of candidates were vaccinated, 7.5% (CI, 6.4% to 8.6%) had no documented vaccination but had documented infection or immunity, and 82.9% (CI, 81.1% to 84.7%) remained candidates. Among patients at facilities funded by the Ryan White HIV/AIDS Program (RWHAP), 12.5% (CI, 11.1% to 13.9%) were vaccinated during the surveillance period versus 3.7% (CI, 2.6% to 4.7%) at facilities not funded by RWHAP. At the end of surveillance, 36.7% (CI, 34.4% to 38.9%) of HIV patients were candidates to initiate vaccination.
The study was not designed to describe vaccine series completion or actual prevalence of immunity.
More than one third of U.S. HIV patients had missed opportunities to initiate hepatitis B vaccination. Meeting goals for hepatitis B elimination will require increased vaccination of HIV patients in all practice settings, particularly at facilities not funded by RWHAP.
Centers for Disease Control and Prevention.
Weiser J, Perez A, Bradley H, et al. Low Prevalence of Hepatitis B Vaccination Among Patients Receiving Medical Care for HIV Infection in the United States, 2009 to 2012. Ann Intern Med. 2018;168:245–254. [Epub ahead of print 26 December 2017]. doi: https://doi.org/10.7326/M17-1689
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Published: Ann Intern Med. 2018;168(4):245-254.
Published at www.annals.org on 26 December 2017
Gastroenterology/Hepatology, HIV, Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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