Antibodies Suggestive of Immunity to Hepatitis A and B Are Not Detected in the Majority of Adolescents and Young Adults Seeking Medication-Assisted Treatment for Opioid Use Disorder

Schimmel/Conrades Science Center Atrium

Opioid drugs, particularly morphine and heroin, can result in relative immunosuppression, negatively impacting both innate and acquired immunity. The Advisory Committee on Immunization Practices (ACIP) recommended in January 1999 routine vaccination of all individuals 0-18 years for hepatitis B. In May 2006, ACIP recommended routine immunization of children >1 year for hepatitis A and vaccination for all injection and non-injection illicit drug users. The objective of this study was to document hepatitis A and B immune and infection status among adolescents and young adults seeking medication-assisted treatment (MAT) for severe opioid use disorder. A retrospective medical record review was conducted of all adolescent and young adults seeking outpatient MAT for severe opioid use disorder from January 1, 2013 to December 31, 2015. Each chart was assessed for hepatitis serology testing. Associations between demographic and clinical characteristics with hepatitis serology status were evaluated using chi-square, Student’s t test, and logistic regression as appropriate. Of the 242 unique patients who presented for MAT, the mean age was 19.4 (SD 1.84), 142 (59%) were female, 233 (96%) were White, Non-Hispanic, and 120 (50%) resided in Franklin County, Ohio. Past heroin use was reported by 203 (84%). Mean age at first opioid use was 15.4 (SD 1.86); mean age at first heroin use was 17.0 (SD 1.88). History of prior drug treatment, injection drug use, and incarceration were reported by: 115 (48%), 161 (67%), and 36 (15%). Evidence of hepatitis C and HIV infection was present in 79 (33%) and 6 (2%). Seropositivity to hepatitis A and B serology was as follows: anti-HAV 46 (19%), HBsAg 2 (1%), anti-HBc 7 (3%), and anti-HBs 68 (28%). Younger age, private insurance coverage, and residence in Franklin County were associated (p<0.01) with seropositivity for anti-HAV. No demographic or clinical variables were associated with seropositivity for anti-HBs. Despite recommendations for routine vaccination, immunity to hepatitis B and A was not evident in the majority of adolescents and young adults seeking MAT. Cellular immunity in the absence of anti-HBs may actually protect an individual from Hepatitis B infection. Further study will explore whether seronegativity to hepatitis A and B is reflective of true lack of immunity, non-immunization status, or immunosuppression from opioid/heroin misuse in this patient population.