Delays in Hepatitis A Vaccination in People With HIV in Houston, Texas Between 2010 and 2018

Authors

Emily T Ciocca
Kristen A Staggers
Jennifer Carey
Antone R Opekun
F Blaine Hollinger
Wendy A Keitel
Robert L Atmar
Hana M El Sahly
Jennifer A Whitaker

Publication Date

1-1-2024

Journal

VaccineX

DOI

10.1016/j.jvacx.2023.100422

PMID

38192618

PMCID

PMC10772366

PubMedCentral® Posted Date

12-14-2023

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

hepatitis A, Human immunodeficiency virus, Vaccination, Immunization, Hepatitis

Abstract

BACKGROUND: Studies have demonstrated low hepatitis A virus (HAV) vaccination rates among persons with HIV (PWH).

METHODS: We conducted a retrospective study of persons entering HIV care at two clinics in Houston, Texas between 2010 and 2018. We defined those eligible for HAV vaccination as those who had no history of HAV vaccination and had a negative anti-HAV IgG at entry to care. Kaplan-Meier curves summarized time to receipt of HAV vaccines. The proportions of patients who received 1 and 2 HAV vaccines at 6, 12, and 24 months were estimated. Cox proportional hazards regression evaluated associations between patient characteristics and vaccination. Significant factors were included in a multivariable Cox proportional hazards model.

RESULTS: Of 6,515 patients, 1372 were eligible for HAV vaccination. Of eligible patients, 29.2 % received 1 HAV vaccination at 6 months, 37.1 % at 12 months, and 47.8 % at 24 months. At 6 months, 10 % received 2 HAV vaccinations, 21.1 % at 12 months, and 33.4 % at 24 months. In multivariable analysis, men who have sex with men (adjusted HR 1.35, 95 % CI 1.06, 1.73) or those who had CD4 count ≥ 200 cells/µl (adjusted HR 2.52, 95 % CI 1.89, 3.37) had their second vaccination sooner than those who were not men who have sex with men or who had CD4 counts < 200 cells/µl, respectively. Patients > 50 years of age had their second vaccination sooner than those aged 30-50 years (adjusted HR 1.47, 95 % CI 1.08, 1.99). Those with active substance history had a longer time to second vaccination compared to those with no substance use history (adjusted HR 0.57, 95 % CI 0.40, 0.82).

CONCLUSIONS: HAV vaccination rates were low and highlight the need for effective solutions to address HAV immunization gaps in PWH, especially among young patients, those with active substance use disorders, and those with significant immunocompromise.

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