P33 Antibodies suggestive of immunity to hepatitis b and a are not detected in the majority of adolescents and young adults seeking medication-assisted treatment for opioid use disorder

Aims Opioid drugs, particularly morphine and heroin, can result in relative immunosuppression, negatively impacting both innate and acquired immunity. Adolescents and young adults (AYA) with history of injection drug use are at high risk for hepatitis infections; therefore, evaluation of their immune status is imperative. The objective of this study was to document hepatitis immune and infection status among AYA seeking medication-assisted treatment (MAT) for severe opioid use disorder. Methods 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 A, B, and C serology testing and prior hepatitis immunization status. Results Among 193 AYA presenting for MAT who had no evidence of prior hepatitis B infection, mean age was 19.3 (SD 1.66), 114 (59%) were female, and 184 (95%) were white non-Hispanic. Mean age at first opioid use was 15.3 (SD 1.85), and mean age at first heroin use was 17.0 (SD 1.87). Injection drug use and prior incarceration were reported by 136 (71%) and 29 (15%). Hepatitis C antibody was positive in 66 (34%). Seropositivity for hepatitis B surface antibody (anti-HBs) and hepatitis A immunoglobulin G (anti-HAV) was 62 (32%) and 45 (23%), respectively. Documentation of hepatitis B immunization initiation was evident in 102 (53%) and completion in 84 (44%). Hepatitis A immunization initiation and completion was present in 38 (20%) and 23 (12%), respectively. Conclusions Despite recommendationsfor routine vaccination, immunity to hepatitis B and A, as assessed by measurement of anti-HBs and anti-HAV, was not evident in the vast majority of AYA seeking MAT. Documentation of appropriate hepatitis immunization was present in a minority of this high risk population. 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.