Response to Hepatitis A and B Vaccine Alone or in Combination in Patients with Chronic Hepatitis C Virus and Advanced Fibrosis

Abstract

Patients with advanced fibrosis are at increased risk of severe outcomes if they develop acute infection with hepatitis A (HAV) or hepatitis B (HBV) viruses. There are no data on the efficacy of combined HAV/HBV vaccination in patients with advanced fibrosis. Our aim was to evaluate the response to the HAV and HBV vaccine alone or in combination for patients with chronic hepatitis C (HCV) and advanced fibrosis and to evaluate the impact of administering the vaccine while patients were receiving peginterferon for treatment of chronic HCV. In this prospective study of patients with advanced fibrosis (Ishak 3-6), those without serologic evidence of prior exposure were vaccinated with either Havrix HAV, Engerix( HBV, or the TWINRIX HAV/HBV combination vaccine as appropriate, and response was defined as the development of anti-HAV or anti-HBV surface antibodies. Of the 162 eligible patients, the prevalence of prior exposure to HAV and HBV was 30 and 18%, respectively. Of the 84 patients vaccinated, 38% received Havrix, 14% Engerix, and 48% TWINRIX. The response to the HAV vaccine was 75% in those receiving Havrix compared to 78% receiving TWINRIX. In contrast, the response to HBV vaccination was 42% in patients receiving Engerix compared to 60% in those vaccinated with TWINRIX (difference 18.3%; OR 0.29; 95% CI: 0.57-7.79). The presence of diabetes was the only risk factor identified for reduced HBV response (P = 0.01). Responses to both HAV and HBV vaccines when administered alone or in combination were lower than expected in patients with HCV and advanced fibrosis, especially in those with diabetes. The observation that the decline in HBV vaccine response was somewhat lower when this was administered alone as opposed to the combination A/B vaccine suggests that the administration of a combination vaccine may enhance the vaccination response to HBV.

Efficacy of Hepatitis B Virus Vaccination and Antibody Response to Reactivation Dose Among Adult Non-Responders to Primary Hepatitis B Vaccination in Chronic Hepatitis C Egyptian Patients

“…However, vaccine response (seroconversion with a hepatitis B surface antibody titer > 10 IU/L) in this setting is often blunted, with poor response rates to a standard course of HBV vaccinations in chronically HCV-infected individuals when compared to the healthy populations (40-60% versus 90-95%); this is especially noted in the setting of advanced fibrosis and liver cirrhosis [11] . Patients with liver cirrhosis had low hepatitis B surface antibody (HBsAb) titers compared to general population.…”

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

“…68–70 Patients with advanced HCV-related liver disease and/or HIV infection may not mount an appropriate immune response to vaccines. 71 Therefore, measurement of HBV antibody titers 3 months after completion of the vaccination series is recommended. 72 …”

Hepatitis A Virus among Drug Users and the Role of Vaccination: A Review

“…The response in terms of seroconversion appears to be conditioned by the degree of fibrosis and by diabetes (Saab et al, 2005; Keeffe, 2006; Buxton and Kim, 2008; Kramer et al, 2009; Lugoboni et al, 2009). Generally, after two doses of HAV vaccine, seroconversion was achieved in a proportion between 75 and 98% of patients with CLD (Buxton and Kim, 2008; de Artaza Varaza et al, 2009; Kramer et al, 2009). Furthermore, there is a good level of evidence that the administration of three doses of combined HAV–HBV vaccine gives better results even in the patients with advanced liver fibrosis (de Artaza Varaza et al, 2009; Kramer et al, 2009).…”

“…Generally, after two doses of HAV vaccine, seroconversion was achieved in a proportion between 75 and 98% of patients with CLD (Buxton and Kim, 2008; de Artaza Varaza et al, 2009; Kramer et al, 2009). Furthermore, there is a good level of evidence that the administration of three doses of combined HAV–HBV vaccine gives better results even in the patients with advanced liver fibrosis (de Artaza Varaza et al, 2009; Kramer et al, 2009). However, it is not known to what extent the lower geometric mean anti-HAV concentrations demonstrated after vaccination in individuals with HCV is translated into a shorter duration of protection against HAV (Buxton and Kim, 2008).…”

“…The authors of both studies concluded by recommending administering the booster-dose after no more than 6 months from the first one because of the initial weak response among DUs. The HAV vaccination schedule currently proposed also for DUs proved ineffective because it has been studied only in the GPOP, where the first dose of vaccine led to seroconversion in almost all cases and where the booster-dose is required only to ensure lasting protection over time (Nothdurft, 2008; Kramer et al, 2009). Further studies are therefore required to optimize the timing and the doses to utilize among DUs to get adequate results.…”