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Quarter Million More With HIV in US-Mostly Women-Should Get Hep A Vaccine: CDC Now Recommends HAV Vax for Everyone With HIV at Least 1 Year Old
  AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
An estimated 275,048 more people with HIV in the United States, including 68% of US women diagnosed with HIV, should get hepatitis A virus (HAV) vaccination, in accordance with a change in Centers for Disease Control and Prevention (CDC) guidelines [1]. The new guidelines recommend that all HIV-positive people 1 year old or older should be vaccinated against HAV infection [2].
HAV infection can result in prolonged circulation of this hepatitis virus in peripheral blood. The virus is highly contagious, spreading via HAV ingestion through close personal contact with an HAV-positive person or through eating contaminated food or drink [3]. Most people recover from HAV infection, but it may rarely lead to liver failure and death, especially in older people and those with chronic liver disease [4].
Before 2020 the CDC recommended HAV vaccination only for certain groups with HIV, including men who have sex with men (MSM), people who use injection or noninjection drugs, homeless people, and people with chronic liver disease. After expanding the recommendation to include everyone with HIV at least 1 year old, the CDC set out to estimate the number of additional HIV-positive people who should get vaccinated.
To make this estimate, the CDC used data from the Medical Monitoring Project (MMP), a population-based survey designed to yield nationally representative estimates of behavioral and clinical traits among HIV-diagnosed US adults. CDC researchers analyzed interview and medical record data from 7634 HIV-positive MMP adults from June 2016 through May 2018 to estimate numbers and percentages of those with or without an indication for HAV vaccination before the 2020 guideline expansion.
Before the 2020 update, researchers estimated that 437,526 HIV-positive people in the United States (49% of all diagnosed with HIV) should get an HAV vaccination because they were MSM, 255,022 (29% of all with HIV) because of noninjection drug use, 119,815 (14% of all with HIV) because of chronic liver disease, 74,528 (8% of all with HIV) because of homelessness, and 19,329 (2% of all with HIV) because of injection drug use.
But an estimated 275,045 people with HIV (31% of all HIV-diagnosed adults) had no indication for HIV vaccination. Those 275,048 people newly eligible for HAV vaccination include 68% of all US women diagnosed with HIV and 19% of all US men diagnosed with HIV.
The CDC investigators concluded that vaccinating this additional quarter-million HIV-positive people against HAV "may reduce the occurrence of prolonged hepatitis A viremia and the potential to transmit hepatitis A."
1. Weiser J, Vu QM, Dasgupta S, et al. Estimating the number of people with HIV who will soon have an indication for hepatitis a vaccination. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract PEC0442.
2. Centers for Disease Control and Prevention. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. Recommendations and Reports. July 3, 2020:69(5);1-38. https://www.cdc.gov/mmwr/volumes/69/rr/rr6905a1.htm
3. Centers for Disease Control and Prevention. Hepatitis A information. https://www.cdc.gov/hepatitis/hav/index.htm 4. Centers for Disease Control and Prevention. Hepatitis A questions and answers for the public. https://www.cdc.gov/hepatitis/hav/afaq.htm#overview