Immunogenicity of recombinant hepatitis B virus vaccine in patients with and without chronic hepatitis C virus infection: A case-control study

Abstract

Immunogenicity of recombinant hepatitis B virus vaccine in patients with and without chronic hepatitis C virus infection:A case-control study. World J Gastroenterol 2007; 13(2): 294-298http://www.wjgnet.com/1007-9327/13/294.asp INTRODUCTIONOne major transmission route for both hepatitis C virus (HCV) and hepatitis B virus (HBV) is the parenteral route, and the sources of infection include administration of blood or blood products [1,2] , intravenous drug use [3,4] and needle-stick accidents [5,6] . According to the analysis of the Third National Health and Nutrition Survey, more than 25% of HCV-positive patients in the United States had hepatitis B markers, a proportion nearly six times that in the HCV-negative group [3] . However, the actual prevalence of HBV infection in patients with HCV infection is probably underestimated [7,8] . Although it has been shown that superinfection of either HBV or HCV may suppress the other's replicative levels, coinfection with both viruses has synergistic effects with regard to histological lesions, progression to cirrhosis and cancer development [9][10][11][12][13] . As such it has been recommended by the National Institutes of Health (NIH) that individuals with HCV be vaccinated against HBV infection to prevent such an outcome [14] . HBV vaccination at standard doses (20 µg for adults at mo 0, 1, and 6) results in an effective antibody response in 90% to 98% of healthy individuals [15,16] . However, reduced immunog enicity of the vaccine has been established in persons with chronic liver disease, patients receiving hemodialysis, patients with HIV infection and those awaiting transplantation [17][18][19][20][21] . To the best of our knowledge, only a few studies, with inconsistent results, have compared the immunogenicity of standard HBV vaccination in chronic hepatitis C patients with that in healthy individuals through a case-control study [22][23][24] . Therefore, we found it valuable to compare the response of standard HBV vaccination between patients with chronic HCV infection and healthy individuals in a prospective case-control study. METHODS: This is a prospective case-control study. A total of 38 patients with chronic HCV infection and 40 healthy controls were included. Vaccination was performed by injection of 20 µg recombinant HBsAg into the deltoid muscle at mo 0, 1 and 6. Anti-HBs concentration was determined 3 mo after the last dose and compared between the two groups. The response pattern was characterized as (1) high-response when the anti-HBs antibody titer was > 100 IU/L, (2) low-response when the titer was 10-100 IU/L and (3) no-response when the titer was < 10 IU/L. MATERIALS AND METHODS Subjects RESULTS:In the patient group, there were 10/38 (26.3%) non-responders, 8/38 (21.1%) low-responders and 20/38 (52.6%) high-responders. The corresponding va l u e s i n t h e c o n t r o l g r o u p w e r e 2 / 4 0 ( 5 . 0 % ) , 7/40 (17.5%) and 31/40 (77.5%), respectively. The response pattern was statistically different between the two groups. In multivar...

Eficacia y seguridad de la vacunación para la hepatitis A y la hepatitis B en pacientes con hepatopatía crónica

“…Las tasas de seroconversión alcanzadas con la vacunación para el VHB en pacientes con EHC varían ampliamente y dependen sobre todo del grado de disfunción hepática. Así, en pacientes con HC por VHC estas tasas oscilan entre el 69 y el 88,5% [21][22][23][24] . Incluso si se emplean dosis mayores (40 mg) y con una pauta acelerada (0, 1 y 2 meses), los resultados son similares (80%) 25 .…”

Hepatitis A and Hepatitis B Vaccination Responses in Persons with Chronic Hepatitis C Infections: A Review of the Evidence and Current Recommendations

“…Two small studies (14,19) reported no significant difference between HCV and healthy cohorts in response to HBV vaccination. Daryani et al (27) found that chronic HCV infection lost its significant correlation to vaccine response when smoking was in the model. In one of the larger studies, using a nonstandard HBV dose and schedule, a significantly lower response was found in individuals with cirrhosis compared with controls and noncirrhotic chronic HCV individuals.…”

“…Finally, Daryani et al (27) compared the response of standard HBV vaccination between patients with chronic HCV confirmed by HCV-RNA and healthy controls. Although a statistically significant difference in vaccine response was observed between those chronically infected with HCV and controls on univariate analysis (73.7% versus 95%), on multivariate analysis, smoking was a significant confounder and when introduced into the model HCV infection, lost its significant correlation with lower antibody response.…”

Response to hepatitis A and B vaccination in patients with chronic hepatitis C: 8-year follow-up

“…4 In patients with CHC, the immunogenicity of the HBV vaccine has been investigated in several studies including adults, and in some the response to the vaccine is reduced. [5][6][7][8][9][10][11][12] This study reports the rate of response to the HAV and HBV vaccines, duration of protection and the incidence of acute HAV or HBV infections during follow-up in patients with CHC compared with healthy controls.…”