Hepatitis B virus vaccination in people with HIV: what's new?

Despite longstanding recommendations for HBV vaccination in people with HIV, coverage has remained low, and vaccine effectiveness has historically been limited due to poor immune responses and rapid waning of protection. This review summarizes recent advances in HBV vaccination strategies, updated guidelines, and emerging risks related to the increasing use of long-acting antiretroviral therapy and worsening vaccine mistrust.

People with HIV experience reduced vaccine immunogenicity and faster waning of protective antibodies. The adjuvanted HepB-CpG vaccine, which includes a TLR-9 agonist, has demonstrated superior seroprotection and durability in both vaccine-naive and previously vaccinated individuals with HIV. Updated guidelines now recommend HepB-CpG as the preferred vaccine. The use of long-acting antiretroviral therapy and oral ART combinations without HBV activity has renewed attention to gaps in HBV immunity and the potential for new HBV infection or HBV reactivation.

HBV vaccination remains fundamental to HBV prevention in PWH, especially as antiretroviral strategies evolve. Broader use of HepB-CpG vaccine, attention to serologic monitoring, and proactive vaccination before antiretroviral switches are essential to reduce HBV-related morbidity and support HBV elimination efforts.