Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review

Table 6 Hepatitis A virus vaccination recommendations by the British human immunodeficiency virus Association, the European AIDS Clinical Society, the US Advisory Committee for Immunization Practices and the World Health Organization

Health Authority	Target candidates	Dosing Schedule	Comments
BHIVA[111]	Household and sexual contacts of infected persons	Monovalent HAV vaccine recommended	We support the BHIVA’s recommendations of targeted vaccination during outbreaks and of stratifying dosing schedule by CD4 counts, particularly administering a 3-dose schedule for those with lower CD4 counts. Despite waning antibody levels, we could not find evidence to justify routine boosters every 10 yr for those at risk. It may be preferable to follow antibody titers and revaccinate seroreverters
	Travellers	Patients with CD4 counts > 350 cells/mm3 should be offered 2 vaccine doses at 0 and 6 mo
	MSM
	Injecting and non-injecting drug users	Patients with CD4 counts < 350 cells/mm3 should receive 3 vaccine doses at 0, 1, and 6 mo
	Individuals at risk of infection during outbreaks
	Those with occupational exposure to HAV (e.g., laboratory workers, sewage workers)	Patients at continued risk of exposure receive a boosting vaccine dose every 10 yr
	Hemophiliacs	Following a significant exposure, HIV-positive contacts who are HAV-seronegative receive post-exposure prophylaxis with the HAV vaccine, with the first dose given as soon as possible and within 14 d of exposure; if the CD4 count is < 200 cells/mm3, they should also receive human normal immunoglobulin
	Residents of care institutions, and their care givers
EACS[112]	Travellers	Vaccinate if seronegative. Did not specify how	Shorter list of at risk candidates for vaccination. Our review supports their recommendation to check antibody titers in individuals with risk profile to guide the need for primary or booster vaccinations
	MSM
	IDUs
	Active hepatitis B or C infection
ACIP[113]	MSM	Monovalent vaccine formulations should be administered in a 2-dose schedule at either 0 and 6-12 mo (Havrix), or 0 and 6-18 mo (Vaqta)	Unlike BHIVA, in addition to the monovalent vaccine formulations, ACIP also recommends the combined hepatitis A and B vaccine
	Injection or non-injection illicit drugs users
	Persons working with HAV-infected primates or
	with HAV in a research laboratory setting
	Persons with chronic liver disease	If the combined hepatitis A and hepatitis B vaccine (Twinrix) is used, administer 3 doses at 0, 1, and 6 mo; alternatively, a 4-dose schedule may be used, administered on days 0, 7, and 21-30 followed by a booster dose at 12 mo	No mention of the need to follow antibody titers or booster vaccines or the application of immunization during outbreaks
	Persons who receive clotting factor concentrates
	Travellers
	Close personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 d after arrival in the United States from a country with high or intermediate endemicity
WHO[114]	Travellers	Inactivated vaccine: 2 doses, the second dose normally 6 mo after the first. If needed, this interval may be extended to 18-36 mo	Does not specify whether all HIV-positive persons should be considered as immunosuppressed patients although evidence from Table 5 suggests that except for the duration of viremia acute HAV is not more severe in HIV-positive compared to HIV-negative patients
	Immunosuppressed patients
	Patients with chronic liver disease

HAV: Hepatitis A virus; HIV: Human immunodeficiency virus; IDUs: Injecting drug users.