Hepatitis B prevention interventions during HIV post-exposure prophylaxis visits: A retrospective chart review

BackgroundHepatitis B virus (HBV) disproportionately affects people at risk of HIV. Encounters for HIV post-exposure prophylaxis (PEP) create opportunities for HBV screening and prevention. We quantified HBV prevalence, susceptibility, and active/passive immunization use among patients seeking HIV PEP.MethodsWe conducted a retrospective chart review of patients requesting PEP at an academic hospital between 2001-2021 in Toronto, Canada. Patients were classified as HBV immune or susceptible based on laboratory tests. Among HBV-susceptible individuals, we quantified how often HBV vaccine and/or hepatitis B immune globulin (HBIG) were administered.ResultsWe identified 2018 PEP episodes, 75.3% being for sexual exposures. Mean age was 33.6 years. Among 1593 (78.9%) participants with available HBV testing data, six (0.4%) tested HBsAg-positive. Of 2018 episodes, 56.8% were among HBV-immune and 19.8% among HBV-susceptible participants; 23.1% were among participants of unknown status. Of susceptible participants, 55 (13.8%) received HBIG and 143 (35.8%) received HBV vaccinations.ConclusionsHBV prevalence was low but roughly one-fifth of patients seeking HIV PEP were HBV-susceptible. HBIG use was inconsistent with current guidelines, and a minority of HBV-susceptible individuals were vaccinated. More systematic HBV testing, increased HBV vaccination and more rational use of HBIG are needed in those seeking HIV PEP.