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HBV Vaccine Improves Survival
With Liver Diseases Beyond HBV Infection
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AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston
Mark Mascolini
Besides preventing HBV infection and thus reducing HBV disease burden, HBV vaccination also improves survival in people with chronic nonalcoholic liver disease, cirrhosis, nonalcoholic liver cirrhosis, and alcoholic liver cirrhosis, according to analysis of the 57,306-person Columbia University chronic liver disease cohort in 2000-2020 [1]. But a huge majority of this cohort, 97%, had no report of getting a hepatitis B surface antigen vaccine.
Researchers from Heidelberg University, Columbia University, and Ajou University in South Korea noted the high success of HBV vaccination in preventing HBV infection and thus the clinical consequences of infection in countries that use the vaccine. But because little work has analyzed the impact of HBV vaccination on overall survival, especially in people with chronic liver disease other than HBV infection, the three-country research team addressed this question by scrutinizing data in the 57,306-person Columbia University chronic liver disease cohort for the years 2000-2020.
Among these 57,306 people with chronic liver disease, records indicated that only 1601 (2.79%) got the HBV vaccine, although 40.58% of enrolled cohort members had cirrhosis. HBV infection had no impact on survival of people with chronic liver disease, regardless of sex, through 8000 days of follow-up. But people vaccinated against HBV had significantly better survival than the unvaccinated (P = 0.000), a result seen in both females (P = 0.000) and males (P = 0.000).
In cohort members with HCV infection, coinfection with HBV had no impact on survival, either in the whole population or in women or men separately through 8000 days of follow-up. But again HBV vaccination rendered a significant survival benefit in the whole group (P = 0.000) and in females (P = 0.000) and males (P = 0.000).
Among people with chronic nonalcoholic liver disease, survival was worse in those infected with HBV (P = 0.007). But HBV vaccination prolonged survival in this population through 8000 days of follow-up in the whole group (P = 0.000) and in females (P = 0.003) and males (P = 0.007).
HBV vaccination improved survival in people with cirrhosis (P = 0.000 for all, for females, and for males). The HBV vaccine had the same benefit in people with nonalcoholic cirrhosis (P = 0.000 for all, for women, and for men) and alcoholic cirrhosis (P = 0.000 for all, P = 0.002 for females, P = 0.000 for males).
The researchers stressed that the low rate of recorded vaccination in this cohort (under 3%) underlines the need "to improve the quality and comprehensiveness of medical records" of people with chronic liver disease. The consistent survival benefit of HBV vaccination confirms the need for universal HBV vaccination "not only for patients with a high risk of hepatitis B infection but also for all patients with chronic liver disease."
Reference
1. Wang K, Itzel T, Daza J, et al. Benefits of hepatitis B virus (HBV) vaccination in patients with chronic liver diseases. AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston.
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