Low Human Papillomavirus Vaccination Coverage in HIV-Positive Patients in Denver, Colorado

Background:

Human papillomavirus (HPV) causes the majority of cervical and anal cancers and a substantial percentage of head and neck cancers.  HPV-related disease is known to be more prevalent and aggressive in persons with human immunodeficiency virus (HIV) co-infection. Despite reassuring data regarding HPV vaccine safety and immunogenicity in patients with HIV, vaccination coverage among the HIV-infected population has not been well described.  We evaluated HPV vaccine coverage at Denver Health, a large urban public healthcare system. 

Methods:

Retrospective, dynamic cohorts were assembled of adult HIV-positive and HIV-negative patients who receive care at Denver Health and who were age-eligible for HPV vaccine according to national guidelines. Each cohort was comprised of patients who visited a primary care clinic twice within an 18 month period while age-eligible for the HPV vaccine, between 2006 and 2014. Vaccination records were compiled from the electronic medical record and the state-wide vaccination registry.

Results:

The HIV-positive and HIV-negative cohorts consisted of 304 and 54,298 patients, respectively.  Rates of HPV vaccination were low in both cohorts. 2.3% of the HIV-positive cohort and 13.2% of the HIV-negative cohort completed the 3-dose vaccine series; vaccination increased by calendar year.  HIV infection (p<0.001) and male gender (p=0.03) were significantly associated with lower rates of HPV vaccine series completion.

Table 1.

	HPV vaccine series initiation (%)	HPV vaccine series completion (%)
HIV-Positive (n= 304)	27 (8.9)	7 (2.3)
Female  (n= 36)	10 (27.8)	1 (2.8)
Male  (n= 268)	17 (6.3)	6 (2.2)
HIV-Negative  (n= 54,298)	13,213 (24.3)	7,159 (13.2)
Female  (n= 34,662)	10,749 (31.0)	6,194 (17.9)
Male  (n= 19,636)	2,464 (12.5)	965 (4.9)

Conclusion:

HPV vaccination rates were much lower in HIV-positive patients than in HIV-negative patients receiving continuity care at Denver Health. Male gender, HIV infection, and earlier calendar year were associated with lower HPV vaccination. A tailored approach is needed to increase provider engagement to strongly recommend the HPV vaccine and enhance patient vaccine awareness.