Four-year follow up of hepatitis C patients vaccinated against hepatitis B virus

Abstract

AIM:Patients with chronic hepatitis C have been recommended to receive vaccinations against hepatitis B. Our study aimed at evaluating the hepatitis B immunogenicity and efficacy against hepatitis B virus infection 4 years after primary immunization series in a group of patients with chronic hepatitis C. METHODS:We recruited 36 out of 48 hepatitis C virus (HCV) infected individuals who were vaccinated against hepatitis B virus (20 g of recombinant HBsAg at 0-1-6 mo schedule) in 1998. Here we measured anti-HBs titers and anti-HBc 4 years after delivery of the third dose of primary immunization series. RESULTS:After 4 years a total of 13/36 (36%) HCV infected patients had seroprotective titers of anti-HBs compared with 9/10 (90%) in the control group, (P<0.05). Similarly the mean concentration of anti-HBs found in hepatitis C patients was significantly lower than that found in healthy subjects (18.3 and 156.0 mIU/mL respectively (P<0.05). None of the HCV infected patients or controls became infected with HBV during the study period as confirmed by anti-HBc negativity. CONCLUSION:We demonstrated that 4 years after HBV immunizations' more than 60% of vaccinated HCV patients did not maintain seroprotective levels of anti-HBs, which might put them at risk of clinically significant breakthrough infections. Further follow-up studies are required to clarify whether memory B and T lymphocytes can provide protection in chronic hepatitis C patients in the absence or inadequate titers of anti-HBs. INTRODUCTIONPatients with chronic hepatitis C have been recommended to receive vaccinations against hepatitis B [1,2] . The rationale behind these recommendations is based on the fact that hepatitis C patients co-infected with hepatitis B virus have an increased histological liver damage and a higher risk of hepatocellular carcinoma [3] . Additionally HCV patients may be at a higher than an average risk of acquiring hepatitis B because of the similar routes of transmission of both viruses. Several studies have shown that certain groups like intravenous drug users, haemodialysis patients, haemophiliacs, and promiscuous people frequently have markers of both infections. In a cross-sectional study of general population in the United States of America, more than 25% of HCV patients had also hepatitis B markers -which was nearly six times higher than in the HCV-negative group [4] . Previous studies demonstrated the safety of HBV vaccine use in patients with chronic hepatitis C. Immunisations did not aggravate the course of hepatitis C and had no effect on serum HCV-RNA levels [5][6][7] . Our earlier study proved that vaccinations could be safely delivered during treatment with interferon [5] . Studies of the hepatitis B vaccine immunogenicity in patients with hepatitis C have yielded mixed results. Most of them (but not all) indicated a diminished response to HBV vaccine delivered in a standard dose and schedule [5][6][7][8] . In our own experience, the HBV vaccine immunogenicity in patients with hepatitis C was decreased. On...

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

“…The overall seroconversion rates 1 month after a single booster dose were 80% in patients and 96% in controls, which is compatible with studies reporting reduced vaccine immunogenicity in patients with CHC compared with healthy individuals. 9,10,12 As in previous reports including adults, 6,7,9,12 no correlation was observed between antibody response and age, gender, body mass index, baseline ALT levels, HCV viral load and stage and grade of liver disease. The anti-HBs seroconversion rates were different between those who responded to treatment with interferon-a and ribavirin administered after primary hepatitis B vaccination and those who did not (P50.02).…”

“…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.…”

Viral interaction and clinical implications of coinfection of hepatitis C virus with other hepatitis viruses

“…Anti-HCV-positive patients, however, appear to have a decreased responsiveness to the HAV or HBV vaccines [92][93][94][95], and Leroy et al [96] demonstrated that HCV viraemia levels were inversely correlated with titres of anti-HBs developing after vaccination. HCV infection impedes dendritic cell maturation and T-cell proliferation [97][98][99], and the dysfunction of these cells impairs Blymphocyte proliferation.…”

Impaired long-term anti-HBs responses in choronic hepatitis C patients: Results from a five-year follow-up study with healthy control

“…A Poland study reported more than 60% CHC patients lost protective anti-HBs four years after HepB immunization and anti-HBs level at follow-up were much lower among CHC patients compared with healthy control (18.3 mIU/mL vs 156.0 mIU/mL), which was in line with the present study. 17 …”