HBV vaccine nonresponders should be considered for revaccination after HCV cure
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Key takeaways:
- Approximately 70% of previous nonresponders to the HBV vaccine developed a response after HCV treatment and cure.
- Age, HIV status and fibrosis degree did not seem to impact vaccine response.
People who were not responsive to hepatitis B vaccination should be considered for revaccination following hepatitis C cure, researchers reported.
“We know that the immune system is disarranged in hepatitis C infection, and our team has published before that individuals with hepatitis C do not mount a great response to the hepatitis B vaccine,” Jose D. Debes, MD, MS, associate professor in the department of medicine at the University of Minnesota, told Healio.
“Recent data also show that upon treating hepatitis C, it seems that the immune system (within the liver at least) returns to a more normal pattern. So, we wanted to address if individuals that did not respond to the HBV vaccine before would respond after treatment of HCV,” Debes said.
The FDA in 2021 approved a trivalent HBV vaccine, which was found to be significantly more effective than previous monovalent vaccines.
Previous studies have shown that HBV vaccine awareness among primary care physicians is exceedingly low, and that educating clinicians who treat HCV on the vaccine could help improve cure rates of HCV and prevent new cases of HBV.
To assess whether revaccination after HCV treatment resulted in improved response, Debes and colleagues prospectively recruited previous HBV vaccine nonresponders for revaccination after HCV eradication. According to the study, hepatitis B surface antibody (HBsAb) testing was performed 1 month after series completion.
Overall, follow-up HBsAb testing was performed in 31 out of 34 enrolled patients, with 21 (67.7%) yielding reactive results, eight nonreactive (25.8%) and two with equivocal results (6.5%).
The researchers wrote that these are still lower reactivity rates than what are observed among HCV-negative people who typically have rates of seroconversion after revaccination around 90% but were still “significantly better than nonresponse.”
Additionally, the researchers explained that isolated hepatitis B core antibodies (HBcAb) and advanced age have both been associated with decreased HBV vaccine response in first-time recipients of the vaccine after treatment for HCV. However, they did not find any association between age or presence of HBcAb in response to reapplication of HBV vaccine.
Additionally, they found that there was no association between nonresponse and having advanced fibrosis, being on hemodialysis or having HIV coinfection — although they noted there were few patients in the study on hemodialysis or with HIV coinfection, making it difficult to draw any significant conclusions.
“The main message is that providers should check HBV immune-protection in HCV-infected patients, and if negative, these individuals should be offered the HBV vaccine following HCV treatment,” Debes said. “This is of particular importance in those at high risk for HBV infection.”
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