Delays in hepatitis B immunization series completion in people with HIV

Abstract Background Studies have demonstrated low hepatitis B virus (HBV) vaccine series completion among persons with HIV (PWH). Methods We conducted a retrospective chart review of persons entering HIV care at two clinics in Houston, Texas between 2010-2018. Kaplan-Meier curves summarized time to receipt of HBV vaccines for those eligible for vaccination. The proportions of patients who received 1, 2, and 3 HBV vaccine doses at 12 and 24 months from entry to care were estimated. A Prentice Williams and Peterson total time (PWP-TT) model was used to evaluate associations between patient characteristics and time to vaccination. Results Of the 5357 patients who entered care, 2718 were eligible for HBV vaccination. After two years of follow-up, 51.2% of those eligible received one HBV vaccine, 43.2% received two vaccines, and 28.4% received three vaccines. When adjusting for significant cofactors, patients whose CD4 ≥ 200 (adj. HR 1.43, 95% CI: 1.29, 1.59) and transgender patients (adj. HR 1.49, 95% CI: 1.08, 2.04) received any given vaccine dose sooner compared to those with CD4 < 200 or were cisgender, respectively. Compared to non-Hispanic Whites, Hispanic patients were vaccinated sooner (adj. HR 1.28, 95% CI: 1.07, 1.53). Those with an active substance use history had a significantly longer time to vaccination compared to those with no substance use history (adj. HR 0.73, 95% CI: 0.62, 0.85). Conclusions Strategies are needed to increase HBV vaccine completion rates in our study population, particularly among those with CD4 <200 and with a substance use disorder.