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Decreased immunogenicity of recombinant hepatitis B vaccine in chronic hepatitis C
M Wiedmann1, U G Liebert, U Oesen
1Department of Medicine II, University of Leipzig, Germany.
Insights
Hepatitis B vaccination shows a high nonresponse rate in chronic hepatitis C patients. Antibody titers should be checked, and booster doses may be needed for effective protection against hepatitis B.
Area of Science:
- Immunology
- Hepatology
- Vaccinology
Background:
- Hepatitis B vaccination is recommended for patients with chronic hepatitis C.
- The immunogenicity of hepatitis B vaccine in this population is not well understood.
Purpose of the Study:
- To evaluate the immunogenicity of a standard recombinant hepatitis B vaccine regimen in patients with chronic hepatitis C.
- To compare the response rates to hepatitis B vaccination between chronic hepatitis C patients and healthy individuals.
Main Methods:
- A prospective open trial involving 59 patients with chronic hepatitis C and 58 healthy controls.
- Patients received recombinant hepatitis B vaccine (10 microg) at months 0, 1, and 6.
- Nonresponse was defined as anti-HBs <10 mIU/mL at 9 months; low response was anti-HBs 10-99 mIU/mL.
Main Results:
- A significantly higher rate of primary nonresponse (31%) was observed in chronic hepatitis C patients compared to healthy controls (9%).
- Low response rates were similar between groups (19% vs. 17%).
- High-dose booster vaccination achieved seroconversion in 80% of primary nonresponders.
Conclusions:
- The standard hepatitis B vaccine regimen has a surprisingly high primary nonresponse rate in patients with chronic hepatitis C.
- Monitoring anti-HBs titers post-vaccination is crucial for this patient group.
- Higher booster doses may be necessary to ensure seroprotection in chronic hepatitis C patients.
Abstract:
The immunogenicity of hepatitis B vaccine is unknown for patients with chronic hepatitis C, although hepatitis B vaccination is highly recommended in these patients. We therefore studied in a prospective open trial of 59 patients with chronic hepatitis C (mean age 42 years, hepatitis C for >10 years, Child-Pugh score < or = 5) and 58 healthy hospital staff persons the rate of nonresponse (anti-HBs <10 mIU/mL at 9 months) to recombinant hepatitis B vaccine (Gen H-B-Vax(R),10 microg intradeltoidal at month 0, 1, and 6). Nonresponse was observed in 18/59 (31%) patients with chronic hepatitis C and 5/58 (9%) healthy staff persons (P <.005) (vs. 7% in historical controls; P <.005), low response (anti-HBs 10-99 mIU/mL) in 19% of patients with chronic hepatitis C and 17% of staff persons. High-dose booster vaccination led to seroconversion in 12/15 (80%) of primary nonresponders. Primary nonresponse to HB vaccine was related neither to presence of early-stage liver cirrhosis nor magnitude of serum hepatitis C virus (HCV) RNA concentration, nor explained by the presence of human leukocyte antigen (HLA) types (B8 DR3, B44, DR7, DQ2) predisposing to low antibody response to hepatitis B surface antigen. The rate of primary nonresponse to the standard regimen of recombinant hepatitis B vaccine is surprisingly high in patients with longstanding chronic hepatitis C. Therefore, the antibody to HBV surface antigen (anti-HBs) titer response should be determined in these patients. Depending on the response titer, higher booster doses may be required to achieve and maintain seroprotection in these patients.