Prevention of hepatitis B virus infection in the HIV-infected adult
- Kenneth E Sherman, MD, PhD
Kenneth E Sherman, MD, PhD
- Professor of Medicine
- University of Cincinnati College of Medicine
- Chloe L Thio, MD
Chloe L Thio, MD
- Professor of Medicine
- Johns Hopkins University
It is important to prevent hepatitis B virus (HBV) infection in HIV-infected individuals. HIV-infected patients are at high risk for acquiring HBV due to shared routes of transmission (eg, sexual transmission, injection drug use) . In addition, if acquired, HIV-infected individuals are less likely to develop a protective immune response with production of hepatitis B surface antibody during acute infection. Thus, such patients are at increased risk of developing chronic infection, cirrhosis, and end-stage liver disease compared with HIV-uninfected patients [2-4].
This topic will address how to prevent HBV in HIV-infected individuals. The epidemiology, clinical manifestations, evaluation, and treatment of HBV in HIV-infected patients are discussed elsewhere. (See "Treatment of chronic hepatitis B in the HIV-infected patient" and "Epidemiology, clinical manifestations, and diagnosis of hepatitis B in the HIV-infected patient" and "Pretreatment evaluation of chronic hepatitis B virus infection in the HIV-infected patient" and "Monitoring the HIV-infected patient with chronic hepatitis B virus infection".)
HIV-infected patients should be vaccinated against HBV if they do not have evidence of protective immunity. Individuals are most likely to develop a protective serologic response if their CD4 count is >350 cells/microL and their HIV viral load is undetectable [5-8]. (See 'Whom to vaccinate' below and 'Dose and schedule of vaccination' below and 'Response to vaccination' below.)
Serologic testing should be performed one month after vaccination to confirm that the patient is immune. Repeat vaccination may be needed for some individuals. (See 'Assessing vaccine response' below and 'Anti-HBs ≤10 milli-international units/mL after initial series' below.)
Although vaccination is the best way to prevent HBV infection, additional prevention interventions may be needed, especially during the course of vaccination and for those who do not respond to the vaccine. These include behavioral interventions to decrease high-risk behaviors and possibly hepatitis B immune globulin if an exposure occurs. Antiretroviral agents used to treat HIV (eg, tenofovir, lamivudine, emtricitabine) may also provide protection against HBV infection. (See 'Avoiding HBV exposure' below and 'Post-exposure prophylaxis' below and 'The role of antiretroviral therapy' below.)
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- SEROLOGIC SCREENING
- Whom to vaccinate
- Vaccine formulations
- Dose and schedule of vaccination
- - Initial series
- - Accelerated dosing schedule
- - Missed doses
- Patients with isolated anti-HB core antibody
- Safety and adverse events
- Response to vaccination
- - Assessing vaccine response
- - Likelihood of response
- Management based upon vaccine response
- - Anti-HBs >10 milli-international units/mL
- - Anti-HBs ≤10 milli-international units/mL after initial series
- - Anti-HBs ≤10 milli-international units/mL after repeat vaccination
- - Waning immunity
- AVOIDING HBV EXPOSURE
- POST-EXPOSURE PROPHYLAXIS
- THE ROLE OF ANTIRETROVIRAL THERAPY
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS