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High HBV Screening Rate in US Veterans Group With HIV
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IDWeek, October 16-19, 2024, Los Angeles
Mark Mascolini
Among more than 30,000 beneficiaries of the US Veterans Health Administration (VHA) with HIV infection, more than 80% had complete hepatitis B virus (HBV) serologic screening in recent years [1]. Blacks, Hispanics, and people with unstable housing had higher odds of complete HBV screening.
Almost 1 in 10 people with HIV in the United States is also infected with HBV, noted researchers from Washington DC VA Medical Center/George Washington University, citing prior work by others [2]. People with HIV get infected with HBV at about a 100-fold quicker pace than the general US population [3]. A 2004-2006 study of US men who have sex with men found only half got screened for HBV and only one quarter of those eligible for HBV vaccination got the shots [4].
The veterans analysis focused on people who had at least one healthcare visit in the VHA system in the current or previous calendar year. The investigators defined complete HBV screening as assays for hepatitis B surface antigen (HBsAg), anti-hepatitis B surface antibody (anti-HBs), and anti-hepatitis B core antibody (anti-HBc). All data for the study came from the VHA Corporate Data Warehouse.
Among 30,412 VHA beneficiaries with HIV, 81.9% had complete HBV serologic screening. While 7% of the group had no results available, 6.2% had no record of an anti-HBc result.
Multivariate logistic regression independently linked several sociodemographic and clinical variables to higher odds of complete HBV screening in this HIV cohort at the following adjusted odds ratios (aOR) and 95% confidence intervals (95% CI):
- Birth cohort 1961-1970 (vs 1951-1960): aOR 1.10, 95% CI 1.01 to 1.21
- Birth cohort 1971-1980 (vs 1951-1960): aOR 1.43, 95% CI 1.27 to 1.61
- Birth cohort 1981-1990 (vs 1951-1960): aOR 1.40, 95% CI 1.24 TO 1.59
- Birth cohort 1991 or later (vs 1951-1960): aOR 1.38, 95% CI 1.12 to 1.69
- Black race: aOR 1.41, 95% CI 1.12 to 1.76
- Hispanic ethnicity: aOR 1.23, 95% CI 1.07 to 1.40
- Homelessness: aOR 1.24, 95% CI 1.09 to 1.41
- HCV: aOR 1.47, 95% CI 1.31 to 1.65
Logistic regression tied several other comorbidities to higher odds of complete HBV screening: alcohol use disorder, alcoholic liver disease (aOR 1.74, 95% CI 1.40 to 2.17), opioid use disorder, stimulant use disorder, chronic kidney disease (aOR 1.95, 95% CI 1.30 to 2.93), and mental health disorders.
This analysis nosed out a trend toward lower odds of complete HBV screening in VHA beneficiaries assigned female versus male at birth: aOR 0.88, 95% CI 0.75 to 1.04. As in all US veterans studies that include both females and males, males vastly outnumbered females in this analysis, 29,293 versus 1219.
A separate logistic regression analysis independently tied geographic and facility-related factors to lower odds of complete HBV screening: rural facilities, smaller facilities that provide more basic care, and facility location in the Midwest or South. VHA beneficiaries cared for in Northeast facilities had a higher chance of complete HBV screening.
Analysis including people without positive HBV surface antibody and excluding those with positive HBV surface antigen figured that 55% of this group got at least 1 dose of the HBV vaccine. But vaccination in the VHA system cannot be called quick: A median 370 days elapsed between HBV screening and vaccination.
The investigators cautioned that limiting their analysis to VHA lab data may underestimate HBV screening and vaccination rates by excluding veterans who get some care outside the VHA system. They reminded colleagues that current US guidelines recommend universal HBV screening for people with HIV, including HBsAg, anti-HBs, and anti-HBc [5].
References
1. Stone S, Lee RR, Beste R, et al. Hepatitis B screening among persons with HIV receiving care from the U.S. Department of Veterans Affairs. IDWeek, October 16-19, 2024, Los Angeles. Abstract 158.
2. Spradling PR, Richardson JT, Buchacz K, et al. Prevalence of chronic hepatitis B virus infection among patients in the HIV Outpatient Study, 1996-2007. J Viral Hepatol. 2010;17:879-86. doi: 10.1111/j.1365-2893.2009.01249.x. PMID: 20158604. https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2009.01249.x
3. Sladic JM, Taylor BS, Thamer M, et al. Who is at risk for new hepatitis B infections among people with HIV? Open Forum Infect Dis. 2023;10:ofad375. doi: 10.1093/ofid/ofad375. PMID: 37539064; PMCID: PMC10394987. https://academic.oup.com/ofid/article/10/8/ofad375/7225102
4. Hoover KW, Butler M, Workowski KA, et al. Low rates of hepatitis screening and vaccination of HIV-infected MSM in HIV clinics. Sex Transm Dis. 2012;39:349-353. doi: 10.1097/OLQ.0b013e318244a923. PMID: 22504597S. https://journals.lww.com/stdjournal/abstract/2012/05000/low_rates_of_hepatitis_screening_and_vaccination.8.aspx
5. Office of AIDS Research. National Institutes of Health Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV. Hepatitis B virus infection.
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-b-virus?view=full
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