Response to Hepatitis B Vaccine in Egyptian Chronic Hepatitis C Patients

Abstract

Background and study aim: Egypt unfortunately has the highest worldwide prevalence of chronic hepatitis C (CHC). Patients with CHC are advised to be vaccinated against hepatitis B virus (HBV) infection. Response to hepatitis B vaccination and risk factors for a weak response are not clearly defined.. The aim of this study is to assess the response to hepatitis B vaccination in CHC patients and identify predictors of a weak response. Patients and Methods: This prospective study included 112 consecutive adult, treatment-naive, CHC patients (cases group) and 54 non-hepatitis C virus (HCV) subjects (control group). Demographic and laboratory variables including HCV-viral load, schistosomal antibody (Ab) titre, and histopathological examination of liver biopsy were assessed. Three intramuscular 20 µg doses (given at 0, 1 & 6 months) of HBV-vaccine (Euvax-B, Korea) were administered, and hepatitis B surface antibody (HBsAb) titres were evaluated 6-8 weeks after the 3rd dose. Results: Out of 112 CHC patients, five (4.5%) had HBsAb titres of <10 mIU/mL, 20 (17.9%) had <100, and 50 (44.6%) had titres of >1000. In comparison, out of 54 controls, one (1.9%) had a titre of <10 mIU/mL, 2 (3.8%) had <100, and 41 (75.9%) had >1000 (P= 0.001). CHC patients had highly significant lower mean Ab titres than controls (P<0.001). In a univariate regression analysis, HBsAb titre was negatively associated with age (P<0.001), ALT (P=0.03), AST (P=0.03), FIB-4 score (P=0.008) and schistosomal Ab titre (P= 0.007) and positively associated with platelet count (P=0.01). There was no association with gender, BMI, viral load or other variables (including METAVIR grade or stage). A multivariate regression analysis in CHC patients showed that age (P= 0.02) and schistosomal Ab titre (P= 0.04) were independent predictors of HBsAb titre response. Conclusions: CHC patients, particularly of older age or with schistosomiasis, have a significantly weakened response to the HBV-vaccine.