Hepatitis A and Hepatitis B Vaccination

Federal guidelines recommend vaccination against hepatitis A (HAV) and hepatitis B (HBV) for people with chronic HCV, HIV, or both.30,42-45,59 Becoming infected with another hepatitis virus has serious consequences for people with HIV/HCV coinfection:

• HAV can cause sudden hepatic failure in people with chronic HCV.60,61
• Coinfection with HBV and HCV has been associated with more rapid HCV disease progression.30,62

Although vaccinations against HAV and HBV are an important part of care for HIV and HCV, research indicates that vaccination rates are low. A review of HAV and HBV screening and vaccination practices at nine HIV Outpatient Study sites reported wide variability among sites. Of 1,071 patients, 57.2 percent (612) were screened for HAV, and 81.9 percent (877) were screened for HBV, yet only 23.3 percent of those eligible for vaccination against HAV (167 of 716) received one or more doses of HAV vaccine, and just 32.4 percent (198 of 612) of eligible patients received one or more doses of HBV vaccine. In HIV-positive people, vaccination for HAV and HBV is preferable when CD4 cell counts are higher than 200/mL because the immune response to HAV and HBV vaccination decreases at lower CD4 cell counts.64-66