Patients with chronic hepatitis C may have a decreased immune response to a standard schedule of hepatitis B vaccination, according to results of a systematic review and meta-analysis.
“Reactivation of HBV has been reported in HCV and HBV coinfected individuals receiving [direct-acting antiviral] treatment, including individuals with either current or previous HBV infection,” Jiaye Liu, MD, from the Shandon Provincial Center for Disease Control and Prevention, China, and colleagues wrote. “We suggest that hepatitis B vaccination could be utilized as another, optional, prophylactic measure for patients with resolved HBV infection.”
Liu and colleagues identified 11 studies published before March 15, 2017, that met their inclusion criteria. The studies totaled 704 patients with HCV and 812 controls.
Additionally, the studies resulted in 14 data sets, as two studies included data for patients with and without cirrhosis and one study used different vaccination schedules. Two studies reported seroconversion of HBV vaccination according to patients’ clinical stage.
Patients with HCV had a significant decrease in antibody seroconversion compared with healthy controls (OR = 0.17; 95% CI, 0.11-0.28). By classification, patients with cirrhosis had an odds ratio of 0.08 (95% CI, 0.02-0.28), those without cirrhosis had an odds ratio of 0.19 (95% CI, 0.1-0.35), and unclassified patients had an odds ratio of 0.2 (95% CI, 0.07-0.57).
The researchers observed no significant heterogeneity or evidence of publication bias among the studies.
After sensitivity analysis with a fixed-effect model, the odds ratio of HBV seroconversion was not altered (OR = 0.16; 95% CI, 0.11-0.23). Similarly, the odds ratio of HBV seroconversion was not significantly altered after a sub-analysis of trials that evaluated last vaccine dose at 4 weeks from end of treatment (OR = 0.15; 95% CI, 0.05-0.44).
Liu and colleagues noted that alanine aminotransferase and HCV RNA may also affect the response to HBV vaccination among patients with chronic HCV, though they were unable to perform subgroup analysis due to the limited number of studies and unspecific data.
“Further studies are needed to explore the mechanism by which HCV infection influences the immune response to hepatitis B vaccination, and to investigate the optimum vaccination schedule for patients with chronic HCV infection,” the researchers concluded. – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.