Safety and Efficacy of Hepatitis B Vaccination in Cirrhosis of Liver

Roni, D. Ajith; Pathapati, Rama Mohan; Kumar, Arun; Nihal, Lalit; Sridhar, K.; Rajashekar, Sujith Tumkur

doi:10.1155/2013/196704

Cited by 43 publications

(55 citation statements)

References 15 publications

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“…HBV infection in cirrhotic patients may have serious consequences as the clinical phenotype of the disease is much more severe because of the impaired functional capacity of the liver compared to the acute HBV infection in healthy individuals. However, several studies have shown that the immunogenicity following HBV vaccination in patients with liver cirrhosis seem to be ineffective . It has been shown that administration of additional vaccine doses after a primary vaccination series in subjects who do not respond to the vaccination is not associated with the development of adverse events …”

Section: Vaccination Schedulesmentioning

confidence: 99%

“…However, the efficacy of the HBV vaccine immunization depends on various factors such as increasing age, obesity, and existence of underlying diseases . Attempts to immunize patients with liver cirrhosis with the standard dose have been proven relatively ineffective . The seroconversion rates and antibody titers among these patients have been shown to be much lower compared to healthy individuals .…”

Section: Introductionmentioning

confidence: 99%

“…Attempts to immunize patients with liver cirrhosis with the standard dose have been proven relatively ineffective . The seroconversion rates and antibody titers among these patients have been shown to be much lower compared to healthy individuals . Many attempts have been performed to improve the immunogenicity of the HBV vaccination by increasing the standard dose of the vaccine or accelerating the dose schedule …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Response to hepatitis B vaccination in patients with liver cirrhosis

Αγγελετοπούλου

Davoulou

Konstantakis

et al. 2017

Reviews in Medical Virology

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Hepatitis B vaccination is strongly recommended for all infants and children but also for adults who are at risk of HBV infection. Attempts to immunize patients with liver cirrhosis have been proven relatively ineffective, and several strategies have already been used to improve the immune response in this group. The primary aim of this review is to examine, discuss, and summarize the immunogenicity of hepatitis B vaccination in patients with liver cirrhosis. MEDLINE search identified 11 studies (n = 961). The dose of the vaccine and the schedule of the vaccination varied. The response rates to the HBV vaccination ranged from 16% to 87% among patients with cirrhosis regardless of the number and vaccine dose. In particular, patients who received the standard dose of vaccination achieved seroprotection rates ranged from 16% to 79% (mean response rate 38%) and those who received a double dose achieved relatively better seroprotection rates (range: 26%-87%; mean response rate 53%). The overall mean response rate to the HBV vaccination was 47%. In conclusion, cirrhotic patients achieve lower seroprotection rates after the completion of HBV vaccination series. Several strategies have tried to improve the immunogenicity; however, there is a great need for additional studies to further explore (1) the immune response in relation to poor vaccination responsiveness confounding factors, (2) novel strategies to improve immunogenicity, and (3) the immune mechanism underlying the differences in response rates to HBV vaccination.

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Section: Vaccination Schedulesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Response to hepatitis B vaccination in patients with liver cirrhosis

Αγγελετοπούλου

Davoulou

Konstantakis

et al. 2017

Reviews in Medical Virology

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“…There were insufficient clinical data to determine whether any of those with positive HBcAb status had taken up vaccination which was subsequently unsuccessful, with or without the influence of advanced liver disease. However, rates of vaccine efficacy are almost 90% in those with compensated cirrhosis and higher in those without significant liver disease . Given the low rates of vaccine uptake in PWID population, it is improbable that the association between HBcAb and cirrhosis is due to vaccine nonresponse, and then, subsequent infection with HBV is already in cirrhotic individuals.…”

Section: Discussionmentioning

confidence: 99%

Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population‐level analysis

Wang

Swann

Thomas

et al. 2018

Journal of Viral Hepatitis

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Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01-1.65) and HCC (HR: 1.64, 95% CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95% CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy.

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“…Thus, many providers use only the double dose vaccine with either three or four injections [58]. Although some protection from HBV vaccine exists even when anti-HBsAb titers drop below 10 mIU/mL, data in other immunocompromised hosts (for example end-stage liver disease) suggests that there is benefit from boosting HBV immunity when anti-HBsAb titers fall <10 IU/mL [59].…”

Section: Hbv Vaccinationmentioning

confidence: 99%

Emerging Challenges in Managing Hepatitis B in HIV Patients

et al. 2015

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Roughly 10 % of HIV-positive individuals worldwide have concomitant chronic hepatitis B virus (HBV) infection, with large differences between geographical regions and/or risk groups. Hepatitis B is a preventable infection with vaccines. However, it cannot be eradicated once acquired, resembling HIV and in contrast with HCV. In developed countries, hepatitis B exhibits particular features in the HIV population. First, HBV infection is less frequently misdiagnosed than in the general population. Second, nucleos(t)ide analogs active against HBV are widely used as part of antiretroviral combinations and are taken by most HIV patients. Lastly, as the HIV population ages given the success of antiretroviral therapy, non-AIDS co-morbidities are becoming a major cause of disease, for which specific drugs are required, increasing the risk of interactions and hepatotoxicity. Furthermore, concern on HBV reactivation is rising as immunosuppressive drug therapies are increasingly been used for cancers and other non-malignant conditions. In this scenario, new challenges are emerging in the management of hepatitis B in HIV-positive individuals. Among them, major interest is focused on failures to suppress HBV replication, HBV breakthroughs and reactivations, the meaning of isolated anti-HBc, screening for liver cancer, and the complexity arising when hepatitis viruses C and/or D are additionally present. This review will focus on these challenges and the major advances in HBV coinfection in HIV.

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Safety and Efficacy of Hepatitis B Vaccination in Cirrhosis of Liver

Cited by 43 publications

References 15 publications

Response to hepatitis B vaccination in patients with liver cirrhosis

Response to hepatitis B vaccination in patients with liver cirrhosis

Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population‐level analysis

Emerging Challenges in Managing Hepatitis B in HIV Patients

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