Evaluation of response to hepatitis B vaccination in chronic hemodialysis patients

Abstract

Background:Hemodialysis (HD) patients are at an increased risk of acquiring hepatitis B virus (HBV) infection. Active HBV immunization in these patients is recommended. A response rate in HD patients is variable but generally lower than healthy individuals.Objective:The aim of this study is to assess the response of HD patients to the HBV vaccine and correlate response and long-term immunity to various clinical and biomedical factors.Patients and Methods:One hundred and one patients, with a mean age 48.7 ± 18.5 years, received 40 μg of HBV vaccine administered intramuscularly in the deltoid region at 0, 1, 2 and 6 months. The patients' responses to the vaccine were determined by measuring hepatitis B surface antibody (HBsAb) 6 weeks after the last injection and monitored thereafter at 3-month intervals.Results:Seventy-one patients (70.3%) mounted a response with HBsAb >10 mIU/ml 6 weeks following the fourth dose of vaccine, and thus were considered considered as adequate responders. Forty-nine (48.5%) patients mounted an excellent response with HBsAb >100 mIU/ml 6 weeks after the fourth dose. Thirty patients (29.7%) were nonresponders. Responders were significantly younger than nonresponders (P = 0.01). Gender, hemoglobin level, serum albumin, ferritin, parathyroid hormone level and hepatitis C virus infection had no effect on the response to the vaccine. Similarly, there was no difference in diabetic state and adequacy of HD between the two groups. Fifty-nine patients (88%) had persistent protective antibodies at 1 year, while eight (12%) lost such protection. Predictors of persistent immunity at 1 year were high HBsAb level at the completion of the vaccination regime and, to a lesser extent, young age.Conclusion:A 70% response rate to HBV vaccine was observed in the cohort of this study. Young age predicts a favorable response to HBV vaccine in HD patients. High (>100 mIU/ml) HBsAb levels achieved at vaccine completion predict persistent immunity at 1 year.

An Investigation of the Immune Response to Hepatitis B Vaccination in Hemodialysis Patients at Dialysis Centers of Tehran (2016)

“…There was no association between gender and the rate of the response to the HB vaccine. Different results have been reported for the relationship between these two variables in various studies, with positive correlations reported in some studies [9,[15][16][17] and negative correlations in some others [1,3]. These differences could be explained by intrinsic differences between men and women in their ability to respond to superficial hepatitis antigens.…”

“…The results of this study showed no association between the rate of the response to the HB vaccine and T2DM, HTN, as well as renal transplantation among participants. There are controversial findings in similar studies about the relationship between these variables, especially between T2DM and the response to the HB vaccine [1,13,16,17]. There are some hypotheses about the impaired response to the HB vaccine in diabetic persons, which include a reduction in the number of circulating helper T cells, the CD4-to-CD8 lymphocyte ratio, lymphocyte blastogenesis, and the presence of DR3, DR7, and DQ2 human leukocyte antigen alleles in diabetic people [22].…”

The Immune Response after Double Dose Hepatitis B Vaccination in Hemodialysis Patients: Influence of Age and Hepatitis C Virus

“…This contradiction may be explained by the difference in methodology, as in this study, antibody titer was calculated only six weeks after the last dose, and in the present study, the same levels were calculated three months after the last dose. 11 Saco et al reviewed the published research data and stated that HBV response is poorer in Hepatitis-C patients and even worse in patients with cirrhotic liver. The underlying pathological mechanism is related to deficiency of programmed death 1 (PD-1) receptors, whose concentration is inversely correlated with immune cells (T & B lymphocytes) activation.…”

“…Liver size more than 16 cm on ultrasound was considered as enlarged. 11 As per hospital protocol, all the patients were given 40 micrograms of HB vaccine (double dose) as a first dose, then a second dose on day-30, followed by the third dose on day-60, while the last dose was given six months after the first dose. The patients who had completed three doses during data collection were also included in the study.…”