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Over one-third of people receiving medical care for HIV infection have not been hepatitis B and only one in ten of these vaccination candidates receives a dose of hepatitis B vaccine during one year of ongoing HIV care HIV negatively affects all phases of hepatitis B infection and liver related mortality in which hepatitis B plays a central role is the leading cause of non AIDS related deaths among people with HIV in addition the incidence of acute hepatitis B infection in this population is about a hundred times higher than in the general population more than twenty years after the recommendation to vaccinate everyone who has HIV infection for hepatitis B the initial decreases in hepatitis B cases and an end-stage liver disease among HIV patients have plateaued the Department of Health and Human Services has outlined strategies for achieving a 60 percent reduction in new hepatitis B cases by 2020 the measured progress towards this goal we needed to know the percentage of HIV patients already vaccinated for hepatitis B we used data from the medical monitoring project in order to describe the unmet need for hepatitis B vaccination we interviewed and reviewed the medical records of over 18000 HIV patients to determine the percentage that had not been vaccinated and had no laboratory evidence of either hepatitis B infection or immunity so what can be done to help more HIV patients be vaccinated for hepatitis B first is to highlight the long-standing recommendation to give the first dose of hepatitis B vaccine during the first HIV care visit just after drawing blood for sexologies and second not to delay vaccinating patients with low cd4 counts third is to provide consistent recommendations across guidelines for the dose and schedule for administering the vaccine fourth is to increase the use of clinical reminders and Standing Orders fifth is to extend coverage through state vaccine programs to include adult vaccinations, and finally it's important that we continue to provide clear messaging about the effectiveness and safety of vaccines working together as clinicians as training program directors as facility administrators and as policymakers we can do better at vaccinating our HIV patients for hepatitis B
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