Effectiveness of hepatitis B vaccination in chronic HCV patients after successful generic direct acting antiviral therapy: significance of isolated hepatitis B core antibodies

Abstract

Objective Previous reports show conflicting results regarding hepatitis B virus (HBV) vaccine efficacy in Hepatitis C virus (HCV) infected individuals and in those with isolated hepatitis B core antibodies (HBcAb). We aimed to evaluate the effectiveness of HBV vaccine and identify possible factors that may contribute to hyporesponsivness in HCV‐treated patients, including those with isolated HBcAb. Methods We conducted a prospective study with 118 enrolled chronic HCV patients who followed a 12‐week regimen of direct acting antivirals (DAAs) and were evaluated for HBV serological markers. Eventually, 98 received appropriate HBV vaccination and were assessed for response. Results A total of 57.1% were vaccine responders although only 5.1% achieved a seroprotective level of HBsAb titre. The response rate was significantly lower among treated HCV patients with isolated HBcAb [2 (5.6%) vs. 40 (64.5%) respectively]. On multivariate analysis, advanced age [OR (95% CI) = 1.09 (1.02–1.17)] and presence of isolated HbcAb [OR (95% CI) = 39.59 (7.98–196.63)] were predictors of vaccine non‐response. In our cost‐effectiveness models, the cost of HBV serological screening was less than the nationally adopted non‐screening approach. A model ratifying reinforced vaccination in non‐responder HBcAb seropositive HCV patients would incur extra cost. Conclusion Hyporesponsiveness to the HBV vaccination is frequent in chronic HCV patients even after achieving SVR following DAAs. Although there is no consensus on the clinical management of patients with isolated HBcAb, our cost‐effectiveness options may support decision‐making for better clinical benefit and proper health investments.

Seroconversion of hepatitis B vaccine among patients from outpatient clinic in Georgia

“…Another prospective study evaluated the seroconversion of the HBV vaccine in chronic HCV patients who had undergone treatment with DAAs. The study found that hypo-responsiveness to the HBV vaccination is frequent in chronic HCV patients even after achieving sustained virologic response following direct-acting antiviral therapy [13] . The evidence from these studies supports the notion that chronic HCV infection is associated with decreased responsiveness to the HBV vaccine.…”

“…Several risk-factors, such as sex, age, smoking, body mass index (BMI), and HCV infection may impact HBV vaccine immunogenicity [10] , [11] , [12] , [13] . Understanding the factors influencing the vaccine response can help to inform vaccination recommendations and improve vaccination rates.…”

Associations of Five Blood Heavy Metals with Hepatitis B Virus Infection and Immunity in Adults: A Cross-Sectional Study

“…HBcAb, or hepatitis B core antibodies, are immunoglobulins produced by the body in response to the presence of HBcAg. These antibodies serve as serological markers to indicate previous or ongoing HBV infection, as they can be detected during both acute and chronic phases of the disease [6,7]. Acute hepatitis B is generally a self-limited condition characterized by hepatocellular necrosis and in ammation.…”

Cured HCV patients with suboptimal hepatitis B vaccine response exhibit high self-reactive immune signatures

“…Several studies have reported that the hepatitis B vaccine response is impaired in chronic HCV-infected patients, 13 – 15 with similar hyporesponsiveness in individuals achieving SVR following DAA treatment. 16 – 18 The factors contributing to suboptimal vaccine efficacy in HCV-infected individuals have not been well characterized. The host immune status plays an important role in determining the strength of the vaccine immune response.…”