Response to an experimental HBV vaccine permits withdrawal of HBIg prophylaxis in fulminant and selected chronic HBV-infected liver graft recipients

Stärkel, Peter; Stoffel, M.; Lerut, Jan; Horsmans, Yves

doi:10.1002/lt.20464

Cited by 53 publications

(53 citation statements)

References 25 publications

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“…[8][9][10][11] Active immunization with standard hepatitis B vaccines in these patients is considered a promising substitute to the current treatment strategy, although the results of this new strategy have been controversial. [12][13][14][15][16][17][18][19][20][21][22] Some studies have reported that responders to hepatitis B vaccination, defined as patients with anti-HBs, should stop taking HBIG and/or antiviral agents. 12,16,17,[20][21][22] However, the safety of discontinuing HBIG and/or antiviral agents in responders remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18][19][20][21][22] Some studies have reported that responders to hepatitis B vaccination, defined as patients with anti-HBs, should stop taking HBIG and/or antiviral agents. 12,16,17,[20][21][22] However, the safety of discontinuing HBIG and/or antiviral agents in responders remains unclear. In the present study, we investigated intrahepatic and extrahepatic HBV total DNA and ccc DNA in responders to active hepatitis B immune reconstitution who had discontinued HBIG and/or antiviral agents and in non-responders to active hepatitis B immune reconstitution.…”

Section: Introductionmentioning

confidence: 99%

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The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

Duan

Wei³

et al. 2015

Human Vaccines & Immunotherapeutics

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These authors equally contributed to the work.Keywords: ccc DNA, HBV reinfection, hepatitis B, liver transplantation, HBV DNA, vaccination Abbreviations: Abbreviations, Full names; HBV DNA, hepatitis B virus total DNA; ccc DNA, covalently closed circular DNA; PBMCs, peripheral blood mononuclear cells; PCR, polymerase chain reaction; anti-HBs, antibodies against hepatitis B surface antigen; HBIG, hepatitis B immunoglobulin; LT, liver transplantation; HBsAg, hepatitis B surface antigen; HBcAg, hepatitis B core antigen; HBsAb, hepatitis B surface antibody; HBeAg, hepatitis B e antigen; HBeAb, hepatitis B e antibody; HBcAb, hepatitis B core antibodyTo investigate the levels of hepatitis B virus total DNA (HBV DNA) and covalently closed circular (ccc) DNA in liver transplant recipients who received hepatitis B vaccination, including responders and non-responders, following liver transplantation due to hepatitis B-related diseases and to investigate the efficacy of hepatitis B immune reconstitution against HBV reinfection. Twenty responders and 34 non-responders were enrolled in the present study. The levels of HBV total DNA and ccc DNA in peripheral blood mononuclear cells (PBMCs) and the liver and plasma were detected by real-time polymerase chain reaction (PCR). Fifty-three blood samples and 38 liver allograft tissues were acquired. For the responders, the mean serum titer for anti-HBs (antibodies against hepatitis B surface antigen) was 289 (46.64-1000) IU/ml. Also for the responders, HBV total DNA was detected in PBMCs for one recipient and in the liver for another recipient, but ccc DNA was not detected in either of those 2 recipients. For the non-responders, HBV total DNA was detected in PBMCS for 2 recipients, neither of whom had ccc DNA. Also for the non-responders, HBV total DNA was detected in the livers of 3 recipients, 2 of whom also had ccc DNA. All responders had discontinued hepatitis B immunoglobulin (HBIG), and 13 responders had discontinued antiviral agents. One responder experienced HBV recurrence during the follow-up period. For the majority of liver transplant recipients, no HBV total DNA or ccc DNA was detected in the blood or liver. The lack of HBV total DNA and ccc DNA both in PBMCs and the liver in liver transplant recipients who received hepatitis B vaccination to prevent HBV reinfection should be a prerequisite for the withdrawal of HBIG and/or antiviral agents.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

Duan

Wei³

et al. 2015

Human Vaccines & Immunotherapeutics

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“…Eine aktive Hepatitis B Impfung nach LT mit dem Ziel eine dauerhafte anti-HBs Antwort zu induzieren, ist nur bei wenigen Patienten möglich [102][103][104][105], kann jedoch im Einzellfall unter Beibehaltung der Kombinationsprophylaxe in Erwägung gezogen werden.…”

Section: Reinfektionsprophylaxeunclassified

4. Austrian Consensus-Statement for Diagnosis and Therapy of Hepatitis B 2009

Peck‐Radosavljevic

Deutsch

Ferenci

et al. 2010

Wien Klin Wochenschr

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Hepatitis B is the most common chronic viral infection of the liver. Chronic hepatitis B is estimated to affect at least 350 million people worldwide and is the leading cause of death from liver disease. There have been dramatic developments both in the diagnostic field and in drug treatment of chronic hepatitis B. Today, chronic hepatitis B is a well manageable disease in the vast majority of cases and the main challenge remains the detection of affected patients at an early enough disease stage to prevent end-stage liver disease and its complications. The rapid pace of drug development mandated an update of the Austrian guidelines on the treatment of hepatitis B, which after 1994 and 1998 were now dating back to 2005 in their third version. All chapters from the 3. consensus statement from 2005 were renewed except for the chapter on liver biopsy, which is still valid in its 2005-version. In particular, virologic parameters take now center stage for treatment decisions, HBV-genotyping is now being considered for the choice of treatment, and the oral first line treatment for chronic hepatitis B has been changed. Overall this consensus statement accounts for the major advances in the management of hepatitis B and significantly changes clinical management of patients with hepatitis B in Austria.

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“…Durch den Zusatz immunstimulatorischer Adjuvanzien und/oder den Einsatz einer rekombinanten HBV-Vakzine der dritten Generation unter Einschluss der S-, Prä-S1-und Prä-S2-Proteine konnte eine deutlich bessere Responserate bei LTX-Patienten erzielt werden [71][72][73]. Eine rekombinante Prä-S-Protein enthaltende HBV-Vakzine wurde auch von einer Gruppe in Hongkong, China, bei transplantierten HBV-Patienten eingesetzt (jeweils 40 μg i.m.…”

Section: Neues Aus Studien Mit Hbvimpfstoffen Hoher Immunogenitätunclassified

Aktuelle Konzepte zur Prophylaxe und Behandlung der Hepatitis-B-Virus-Reinfektion nach Lebertransplantation

2008

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Pretransplant complete viral suppression and posttransplant combined hepatitis B immunglobulin (HBIG)/nucleos(t)ide analog therapy lead to successful prevention of hepatitis B virus (HBV) reinfection in approximately 95% of HBV patients. Low-dose intramuscular HBIG protocols have yielded cost reduction by > 50%. However, passive immunoprophylaxis is still expensive and requires close monitoring of the liver transplant (LT) patient. HBIG-free therapeutic regimens with new promising nucleos(t)ide analog combinations are currently being investigated for their efficacy and safety as first-line therapy in clinical studies.Third-generation HBV vaccines, including the S, pre-S1, and pre-S2 regions or combination vaccines with immunostimulatory adjuvants, seem to be more immunogenic than the currently available vaccines and may allow long-term discontinuation of HBIG in selected responders. Adoptive transfer of immunity against HBV was successful in some LT patients in clinical studies. Future investigations need to elucidate, if donor-derived immunity is a transient immunologic phenomenon or persistently controls HBV.

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Response to an experimental HBV vaccine permits withdrawal of HBIg prophylaxis in fulminant and selected chronic HBV-infected liver graft recipients

Cited by 53 publications

References 25 publications

The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection

4. Austrian Consensus-Statement for Diagnosis and Therapy of Hepatitis B 2009

Aktuelle Konzepte zur Prophylaxe und Behandlung der Hepatitis-B-Virus-Reinfektion nach Lebertransplantation

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