Journal Article

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

Kramer, Erik Seth, Shiffman, Mitchell L, Hofmann, Charlotte, Smith, Paula G, Sterling, Richard K

2009

Overview

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.

• Publisher: Boston : Springer US,Springer US,Springer,Springer Nature B.V
• Subject: Antiviral Agents - therapeutic use / Biochemistry / Biological and medical sciences / Feeding. Feeding behavior / Female / Fundamental and applied biological sciences. Psychology / Gastroenterology / Hepatitis A Vaccines - immunology / Hepatitis B Vaccines - immunology / Hepatitis B virus / Hepatitis C virus / Hepatitis C, Chronic - complications / Hepatitis C, Chronic - drug therapy / Hepatitis C, Chronic - immunology / Hepatology / Human viral diseases / Humans / Infectious diseases / Interferon-alpha - therapeutic use / Liver Cirrhosis - etiology / Liver Cirrhosis - immunology / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Oncology / Original Article / Polyethylene Glycols - therapeutic use / Prospective Studies / Recombinant Proteins / Transplant Surgery / Vaccines, Combined - immunology / Vertebrates: anatomy and physiology, studies on body, several organs or systems / Viral diseases / Viral hepatitis