Objective: To assess the prevalence of anti-HAV and hepatitis A vaccination among high risk patients in the outpatient HIV clinic.
Methods: A retrospective review of medical records of high risk adult patients (age > 18y) who attended the outpatient HIV clinic between the period of July 2007 - December 2008. The clinic provides primary care services to approximately 750 HIV-infected patients. The clinic demographics include 47% women, 83% Blacks and 14% Latinos.
Results: 244 high risk HIV infected adult patients had at least one visit within the study period. All received anti-HAV screening, of which 87.3% (n=213) tested negative for anti-HAV and 12.7% (n=31) tested positive. Among those who tested negative, 12% (n=26) had only 1 visit and did not follow up. Of the remaining 187 patients who followed up, 60% (n=113) received at least 1 dose of hepatitis A vaccine and 40% (n=74) did not receive a single dose of vaccine. Among the total 244 patients, 18 had perinatally acquired HIV infection. 88% (n=16) of these patients with perinatal HIV had positive anti-HAV and are responsible for 52% of the total 31 patients with positive antibody. All the 31 patients with anti-HAV had more than 1 visit.
Conclusions: In our cohort of high risk HIV infected adults, patients with perinatal HIV are more likely to have anti-HAV. The prevalence of anti-HAV in our chort is low (12.7%) and similar to the rate reported in other studies. The hepatitis A vaccination rate of 60% in our cohort is below the target of greater than 90% vaccination rate needed for herd immunity to lessen the impact of the disease in the community. The high rate of anti-HAV in patients with perinatal HIV highlights the effectiveness of the strategy for childhood hepatitis A vaccination schedule. Comparable success in adult patients will require a higher adherence to vaccination recommendations in order to prevent HAV infections in high risk HIV patients.