An Assessment of the Prevalence of Hepatitis A Antibody and Vaccination Among HIV Patients in An Inner City HIV Clinic

Background: Routine hepatitis A virus (HAV) screening and vaccination is recommended in the guidelines for the management of high risk persons infected with the human immunodeficiency virus (HIV). Scientific evidence shows that patients with no immunity against HAV suffer prolonged clinical course and hepatitis related liver abnormalities if infected with acute hepatitis when compared to those who have immunity. The infectious disease clinic at this inner city hospital caters for a large population of HIV infected patient. At the initial contact and annually, high risk patients as defined by guidelines are offered screening for HAV antibody (anti-HAV). Patients who are non-immune are vaccinated.

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.