Vaccine-Preventable Hepatitis (VPH) and high-risk patients with HIV.
All forms of viral hepatitis cause up to 15,000 deaths annually in the United States, and it is estimated that one third of the US population will be infected with viral hepatitis at some point in their lives. (1) Nearly 90% of new cases of viral hepatitis arise from Vaccine-Preventable Hepatitis (VPH), a group of diseases that can cause acute illness characterized by flu-like symptoms and jaundice. (1,2) One form of VPH, hepatitis B virus (HBV), can cause chronic conditions, such as cirrhosis and chronic hepatitis, and can lead to liver cancer and death. (2) VPH, which includes hepatitis A virus Noun 1. hepatitis A virus - the virus causing hepatitis A
enterovirus - any of a group of picornaviruses that infect the gastrointestinal tract and can spread to other areas (especially the nervous system) (HAV) and HBV, results in 171,000 total infections and approximately 5100 deaths per year in the United States. (2) VPH can be contracted through sexual activity and the use of nonsterile needles (2); HBV can be transmitted through contaminated blood and bodily fluids. HBV can be 100 times more contagious than human immunodeficiency virus human immunodeficiency virus
Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans. (HW), (3,4) making VPH a serious concern for populations who engage in high-risk behaviors. Although no treatment exists, VPH can be prevented by a series of vaccinations. VPH is the only sexually transmitted disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, preventable through vaccination. (5)
VPH in HIV-Positive Patients
In persons with HIV, coinfection by VPH increases morbidity and mortality and compromises treatment programs. (6) Chronic HBV infection occurs in 10% to 15% of HiV-infected persons, (7) and coinfection with HIV increases the likelihood of acute HBV becoming chronic by 3- to 6-fold. (8) Furthermore, HBV coinfection in AIDS patients reduces survival (212 vs 439 days). (9) HBV coinfection with HIV also complicates the evaluation of hepatotoxicity hepatotoxicity (hepˑ··tō·t , a common side effect of antiretroviral therapy, (7) and HAV in persons with HIV may require suspension of highly active antiretroviral therapy Noun 1. highly active antiretroviral therapy - a combination of protease inhibitors taken with reverse transcriptase inhibitors; used in treating AIDS and HIV
drug cocktail, HAART (HAART HAART highly active antiretroviral therapy.
HAART Highly active antiretroviral therapy, triple combination therapy AIDS The concurrent administration of 2 nucleoside reverse transcriptase inhibitors–eg, AZT and 3TC, and a protease ) due to elevation of liver enzyme levels. (10) In a descriptive study following HIV-positive patients, all 7 patients who developed HAV while on HAART required suspension of therapy. (10) In light of the effects of coinfection with VPH and HW, it should be noted that the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC) recommends HBV immunization for all HIV patients and HAV immunization for all susceptible HIV patients, such as men who have sex with men Men who have sex with men (MSM) is a term used mostly in the United States to classify men who engage in sex with other men, regardless of whether they self-identify as gay, bisexual, or heterosexual. (MSM), intravenous drug users, and persons with chronic liver disease. (11)
VPH and HIV-Risk Populations
Patients who engage in high-risk behaviors for contracting HIV are also at high risk for VPH. (12) Although MSM are at increased risk for VPH due to sexual activity, the majority of these men fail to recognize the inherent risks associated with VPH and consequently are not immunized. (13,14) A national survey of MSM between ages 15 and 22, conducted between 1994 and 1998, found that only 9% of respondents had been immunized against HBV. (15) In one recent study of 833 MSM who received treatment at a clinic for STDs, only 15% were vaccinated for HAV and 25% for HBV. (16) Several medical and public health organizations, including the CDC, the American Academy of Family Physicians American Academy of Family Physicians,
n.pr a national medical organization established in 1947 to promote the practice of family medicine. , the National Medical Association, the Gay and Lesbian Medical Association
ASHA's roots stretch back to the Progressive-era social purity movement. , recommend VPH (hepatitis A and hepatitis B) immunization for MSM.
Vaccination Can Protect Patients With or at Risk for HIV From VPH
Vaccination can provide protection against all forms of VPH in patients who have or are at increased risk for HIV. Supported by numerous national health organizations, VPH immunization can reduce morbidity, mortality, and treatment-associated complications in these patient populations.
Reimbursement for VPH immunization for patients with HIV is covered by most health plans. For these patients, over 90% of top US health plans reimburse primary care physicians and specialists for adult hepatitis vaccines without prior authorization. (17) For more information, contact the VACCRIX Reimbursement Hotline[TM] at 1-888-VACCRIX.
Figure 1. A recent multicenter, prospective cohort study classified 5293 men who had sex with men according to their HIV-1 antibody and hepatitis 13 surface antigen status (HBsAg) to examine liver-related mortality, which was higher in men with HIV-1 and HBsAg than in those with only HIV-1 infection or only HBsAg (P < .001). (6) Effect of HIV/HBV Coninfection on Mortality Liver-related mortality rate (per 1000 persons years) HIV-1 2 HBsAg 1 HIV-1 plus HBsAg 14 Note: Table made from bar graph.
(1.) Centers for Disease Control and Prevention. Disease burden from viral hepatitis A, B, and C in the United States. Available at: http://www.cdc.gov/ncidod/diseases/hepatitis/resource/ PDFs/disease_burden2002.pdf. Accessed August 5, 2004.
(2.) Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. 8th ed. Atkinson W, Hamborsky J, Wolfe S, eds. Washington DC: Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS ; 2004:177-212.
(3.) Centers for Disease Control and Prevention. Prevention and control of infections with hepatitis viruses in correctional settings. MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg, . 2003;52(RR-01):1-33.
(4.) Centers for Disease Control and Prevention. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR. 1991;40(RR-08):1-9.
(5.) Centers for Disease Control and Prevention. Sexually transmitted diseases Sexually transmitted diseases
Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely treatment guidelines 2002. MMWR. 2002;51(RR-6):1-80.
(6.) Thio CL, Seaberg EC, Skolasky R, et al. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet. 2002;360:1921-1926.
(7.) Sulkowski MS, Thomas DL, Chaisson RE, Moore RD. Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA JAMA
Journal of the American Medical Association . 2000;283:74-80.
(8.) Piliero PJ, Faragon JJ. Case report. Hepatitis B virus and HIV coinfection. AIDS Read. 2002;12:443-451.
(9.) Ockenga J, Tillmann HL, Trautwein C, et al. Hepatitis B and C in HW-infected patients. Prevalence and prognostic value. J Hepatol. 1997;27:18-24.
(10.) Fonquernie L, Meynard JL, Charrois A, Delamare C, Meyohas MC, Frottier J. Occurrence of acute hepatitis A in patients infected with human immunodeficiency virus. Clin Infect Dis. 2001;32:297-299.
(11.) Centers for Disease Control and Prevention. Recommended adult immunization schedule by age group and medical conditions, United States, 2003-2004. Atlanta, Georgia: The Advisory Committee on Immunization Practices The Advisory Committee on Immunization Practices (ACIP) consists of fifteen advisors to the Centers for Disease Control and Prevention (CDC), selected by the Secretary of the United States Department of Health and Human Services, to provide advice and guidance on the most effective ; 2004.
(12.) Blatmer WA, Biggar RJ, Weiss SH, et al. Epidemiology of human T-lymphotropic virus type III and the risk of the acquired immunodeficiency syndrome acquired immunodeficiency syndrome, see AIDS. . Ann Intern Med. 1985;103:665-670.
(13.) Centers for Disease Control and Prevention. Undervaccination for hepatitis B among young men who have sex with men San Francisco and Berkeley, California, 1992-1993. MMWR. 1996;45:215-217.
(14.) Centers for Disease Control and Prevention. Hepatitis A vaccination hepatitis A vaccination A vaccination for those in high-risk settings–frequent world travel, sexually active with multiple partners, gay guys, illicit drug use, day care centers, certain health care setting, sewage exposure Vaccines HAVRIX, VAQTA Dosing 2 of men who have sex with men--Atlanta, Georgia, 1996-1997. MMWR. 1998;47:708-711.
(15.) Sansom S, Rudy E, Strine T, Douglas W. Hepatitis A and B vaccination in a sexually transmitted disease clinic for men who have sex with men. Sex Transm Dis. 2003;30:685-688.
(16.) Diamond C, Thiede H, Perdue T, et al. Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors, and vaccination. Sex Transm Dis. 2003;30:425-432.
(17.) Data on file, TWR5004, GlaxoSmithKline.