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Re-vaccination against hepatitis B in previous non-responders following hepatitis C eradication
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Two Thirds of HBV Vax Nonresponders With HCV Do Respond After SVR
AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston
Mark Mascolini
Two thirds of people with HCV infection who did not respond to HBV vaccination did respond after they attained sustained virologic response (SVR) against HCV with direct-acting antivirals (DAAs) [1]. The researchers could not isolate predictors of HBV revaccination response in this 31-person prospective study.
HBV vaccination rates are low in people with chronic HCV infection, probably partly because clinicians know people with HCV may respond to HBV vaccination less efficiently than others. Researchers from Hennepin Healthcare in Minneapolis who conducted this study noted that 20% of people in their health system do not respond to HBV immunization. But people with HCV who forego HBV vaccination run a higher risk of HCV/HBV coinfection and thereby boost their chances of cirrhosis and hepatocellular carcinoma.
The Hennepin group conducted this study to see if HBV-vaccine nonresponders with HCV responded to HBV vaccination better after attaining SVR with anti-HCV DAAs. They recruited adults with HCV infection who did not respond to an HBV vaccine earlier and received at least 2 vaccine doses in the earlier series. All took the ENGERIX-B or HEPLISAV-B vaccine series after scoring an SVR against their HCV infection. The researchers defined response to revaccination as detection of hepatitis B surface antibody (HBsAb) 1 month after completing their HBV vaccine series.
The 31 study participants averaged 59 years in age (range 24 to 76) at the time of their first HBV vaccination, 66% were male, 55% black, and 31% white. Three people (10%) had HIV infection, 6% were HBcAb-positive, and 34% had stage 3 or 4 fibrosis. Sixteen people (52%) completed their first (ineffective) HBV vaccine series and 17 (55%) went more than 12 months between their HBV vaccine series.
Of the 31 revaccinated people, 21 (67.7%) had reactive HBsAb, 8 (25.8%) were nonreactive, and 2 (6.5%) had equivocal results. Univariate analysis determined that gender, race, HIV infection, HBcAb reactivity, time since prior HBV vaccine, F3-F4 fibrosis, and completing the initial vaccine series were not associated with response to revaccination.
Because of the obvious public health implications, the researchers suggested that colleagues consider HBV revaccination after HCV SVR in people who previously did not respond to the HBV vaccine.
Reference
1. Goble S, Powell J, Debes JD. Re-vaccination against hepatitis B in previous non-responders following hepatitis C eradication. AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston.
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