HIV Specialist - June 2021 - 52

CLINICAL RESEARCH
UPDATE
CAROLYN CHU, MD, MSC, AAHIVS
Incoming AAHIVM Chief Medical Officer
FEATURED LITERATURE:
Schnittman SR, Zepf R, Cocohoba J, Sears D. Heplisav-B Seroprotection in People
with HIV: A Single-Center Experience. J Acquir Immune Defic Syndr. 2021 April 1;
86(4): 445-449. doi: 10.1097/QAI.0000000000002573. PMID: 33196553.
Hepatitis B virus (HBV) vaccination for people with HIV (PWH) is an
important prevention intervention that decreases risk of developing chronic liver
disease and related complications such as hepatocellular carcinoma. Among
PWH, serologic response to primary vaccination with older HBV vaccines (e.g.,
Engerix-B, Recombivax HB) varies notably and has led to multiple vaccination
studies and strategies. The purpose of this retrospective cohort study was to
examine seroprotection rates (SPR) and predictors among adults without
current HBV seroprotection (defined as anti-HBs < 10 mIU/mL) followed at
a single quaternary care center HIV clinic who received at least one dose of
Heplisav-B. Heplisav-B was approved in 2017 as a two-dose vaccine and contains
an immunostimulatory adjuvant; of note, PWH were not included in the trials
which led to initial FDA approval. Among 64 PWH engaged in care at the study
location, 63 received a complete two-dose series, and 81 percent demonstrated
post-vaccination seroprotection overall (defined as anti-HBs titers ≥ 10 mIU/
mL); 63 percent achieved anti-HBs titers ≥ 100 mIU/mL. Seroprotection rate
was 86% in patients without significant non-HIV immunosuppression, e.g.
decompensated cirrhosis, solid organ transplantation, metastatic cancer, active
chemotherapy, or asplenia. Seroprotection rates among PWH who underwent
primary vaccination with Heplisav-B versus among PWH without a history of
seroprotection after receiving older HBV vaccines (and subsequently received
Heplisav-B) were 79 percent and 84 percent, respectively. Higher current
and nadir CD4 cell counts were associated with seroprotection (p < 0.001 for
both). There were no differences in pre- and post-immunization HIV viral load
measurements; 90 percent of patients were virologically suppressed on ART.
AUTHOR'S COMMENTARY
This is the first published report describing immunogenicity and factors
associated with seroprotection among PWH who underwent Heplisav-B
vaccination. Research findings presented at CROI and other large scientific
and clinical meetings will likely command HIV providers' attention over the
next few months. However this single-center analysis is informative and
valuable. Despite a relatively small sample size, results suggest Heplisav-B
associated seroprotection rates are high among PWH, especially persons with
high CD4 counts and no significant immunosuppression. Favorable serologic
response rates were also observed among persons who had not responded to
older HBV vaccines. This may inform new revaccination strategies, which might
be especially useful given ongoing differing approaches to revaccination. HIV
providers will likely universally welcome future results from NIAID's
B-Enhancement of HBV Vaccination in Persons Living with HIV (BeeHIVe)
study,* which aims to evaluate response to and safety of Heplisav-B in
populations with HIV (NCT04193189, ClinicalTrials.gov).
*Not yet recruiting
52 JUNE 2021 HIVSPECIALIST WWW.AAHIVM.ORG
FEATURED LITERATURE:
Scherer M, Kamler A, Weiss L, et al. Toward safer opioid
prescribing: effects of the TOWER intervention on
HIV care providers. AIDS Care. 2021 March 9; 1-6. doi:
10.1080/09540121.2021.1887444. PMID: 33719775.
Recent shifts in opioid prescribing practices, although
well-intentioned and necessary at times, have
also led to decreased access and adverse outcomes
for some stable, opioid-treated patients experiencing
chronic pain. TOWard SafER Opioid Prescribing
(TOWER) is a provider-facing intervention designed
to support HIV primary care providers' adherence
to CDC Opioid Prescribing Guidelines. TOWER
includes three components: prescription opioid management
training including patient-recommended
communication strategies; access to patient-reported
risk-benefit data via an app; and a medical encounter
note template. This study describes qualitative
findings of a randomized trial examining outcomes
among TOWER-trained providers versus usual
care. Review of visit content demonstrated greater
guidelines alignment among intervention provider
encounters: topic areas with greatest discrepancies
included discussions of treatment goals and progress
assessment, opioid medication adherence review, and
evaluation (and discussion) of harms/risk factors.
AUTHOR'S COMMENTARY
Opioid use disorder, overdose deaths, and safer
prescribing remain challenging issues for many
providers and communities. These findings suggest
that interventions such as TOWER are feasible and
may help facilitate guidelines-concordant opioid
prescribing and management. Further implementation
and evaluation regarding intervention
effectiveness and patient-oriented outcomes are
important. Additionally, this information may motivate
HIV providers to consider modifications to their
patient interviewing and counseling styles/habits to
include regular, collaborative discussions of benefits/
harms of long-term prescription opioid use and reassessment
of individual treatment goals and progress
toward those goals.
http://www.ClinicalTrials.gov http://WWW.AAHIVM.ORG

HIV Specialist - June 2021

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