HBV Vaccine Recommendations, Catch-Up Efforts Decreased Infection Rate in Patients With HIV

Increased vaccination efforts through general recommendations and catch-up initiatives for hepatitis B virus (HBV) helped to decrease the prevalence of HBV over time in people living with HIV in Germany, according to a study published in HIV Medicine. Prevalence and incidence of HBV in people living with HIV still remained higher compared with the general population.

HBV has a high morbidity and mortality rate due to liver disease caused by the virus, and it is mainly contracted through permucosal transmission and through blood. It was estimated that 28% of mandatory notified cases in 2019 in Germany were through sexual transmission. Infection progresses chronically in 30% to 90% of immune-compromised people compared with only 5%-10% of the general population.

"A highly effective vaccine for the prevention of HBV infection has been available since 1982," the authors noted. "In 1994, the German Standing Committee for Vaccination recommended vaccination for neonates and catch-up vaccination until the age of 18 years."

This study aimed to assess the magnitude of co-infection of HBV and coverage of HBV vaccination over time in people living with HIV in Germany.

Close-up medical syringe with a vaccine | Image credit: weyo - stock.adobe.com

Patients participating in the HIV-1 Seroconverter Study and living with HIV made up the study population. Participants were recruited from 63 study centers throughout Germany and were recruited if they had a known or reliably estimated date of HIV-1 seroconversion. The majority of participants were male and had HIV transmission that was likely due to having sex with other men. The study period ranged from June 15, 1996, to December 31, 2019.

Participants were included if they had at least 1 record of testing for HBV and were seronegative at baseline with an additional record of HBV testing. All plasma samples were used to determine HBV infection from the beginning of the study through June 2012; the last sample of plasma was used for each participant from July 2012 to October 2016. No laboratory testing occurred from 2017 to 2019, but answers to questionnaires were available. Questionnaires were used to determine whether vaccination for HBV was done before or after HIV seroconversion.

There were 3479 patients who were included in this study who had a median (range) follow-up time of 4.3 (0-21) years and a median of 3 (1-23) test results that were received. A total of 95% of participants were male and 87% reported sexual contact with men as the likely place of transmission for HIV. A total of 44% of participants were aged 25 to 34 years; 51% were from Berlin.

There was a 30% prevalence of HBV overall (95% CI, 28%-31%). Resolved HBV infection prevalence decreased from 52% in 1996-1999 to 16% in 2019. Acute/chronic infection prevalence totaled 3.9% (95% CI, 3.3%-4.6%) through the entire study period and decreased overall from 4.1% (95% CI, 2.0%-8.5%) to 1.3% (95% CI, 0.6-2.8). Vaccination was indicated for 54% of participants (95% CI, 52%-55%) in the whole time period and saw an increase from 25% in 1996-1999 to 69% in 2019.

The incidence of HBV was calculated as 2.2 per 100 person-years (95% CI, 1.7-2.9) and the incidence was highest in 2004-2007 at 6.9 per 100 person-years (95% CI, 4.4-12). Testing results found that 57% of participants had an indication of being vaccinated. Vaccination coverage was indicated in 44% of participants in the questionnaires. The median number of doses of the vaccine was 3 (1-20); 38% had reported their first vaccination after HIV infection. A total of 3 participants who were susceptible to HBV and receiving antiretroviral therapy had an incident HBV infection during their treatment.

There were some limitations to this study. There was a low number of participants who were eligible for incidence analysis due to being susceptible to HBV. The incidence rate of 2.2 infections per 100 person-years is also higher than the estimated incidence of 0.01 infections per 100 person-years that was based on mandatory disease notification for 2019.

Acute/chronic and resolved infection of HBV had a decreasing prevalence in people living with HIV in Germany from 1996-2019, according to this analysis. The number of participants who were vaccinated for HBV had also increased to 69%. The authors noted that, although greater protection for those at risk of infection had occurred in the time period, 14% remained unvaccinated and vulnerable to infection, so efforts to increase vaccination should continue.

Reference

Krings A, Schmidt D, Kollan C, et al; the German HIV-1 Seroconverter Study Group. Increasing hepatitis b vaccination coverage and decreasing hepatitis B co-infection prevalence among people with HIV-1 in Germany, 1996-2019. Results from a cohort study primarily in men who have sex with men. HIV Med. Published online October 2, 2023. doi:10.1111/hiv.13554