Response to Hepatitis a/B Vaccine Alone or in Combination in Patients with Chronic Hepatitis C Virus (HCV) and Advanced Fibrosis

Abstract

Purpose: Patients (pts) with HCV may be at risk for exposure to hepatitis A (HAV) or hepatitis B (HBV) due to high-risk behaviors and those with advanced fibrosis are at increased risk of severe outcomes with acute HAV, HBV, or both. Although response to HAV vaccine may not be affected by chronic liver disease, the response to HBV vaccine is low. Because there are no data on whether combined HAV/HBV vaccine increases HBV response in pts with chronic liver disease and advanced fibrosis, we conducted a retrospective cohort analysis to evaluate the response using a HAV/HBV vaccine alone or in combination. Methods: A total of 284 HCV positive pts with advanced fibrosis (Ishak 3–6) were analyzed. The efficacy and risk factors of HAV/HBV vaccine response was evaluated using antibody testing. Those who received the Havrix HAV, Engerix HBV, or the TWINRIX A/B combination vaccine were compared. Response was defined as the presence of anti-HAV or anti-HBV surface antibody in pts who tested negative for HAV and HBV prior to vaccination. Clinical factors between responders and non-responders to each vaccine were compared in univariate analysis and multivariable logistic regression model, controlling for age, sex, Ishak score, BMI, and diabetes was used to identify independent predictors of vaccine response. Results: One hundred and sixty two pts (mean age 55.5, 71.6% male, 59.3% white, 53.7% Ishak 3–4, 46.3% Ishak 5–6) were tested for prior exposure to HAV and HBV. Prevalence of no prior exposure was 69.8% to HAV and 82.1% to HBV. Of the 162, 80 (49.4%) were vaccinated: 36.3% with HAV, 15% with HBV, and 48.8% with Twinrix. HAV response was 72.4% in those receiving the Havrix compared to 76.9% receiving the Twinrix (P= 0.671), while HBV response was 41.7% in pts receiving the Engerix compared to 59.0% in those vaccinated with the Twinrix (difference 17.3%, 95% CI: 0.54–7.48; P= 0.292). The presence of diabetes (DM) was identified as a risk factor in reduced HBV response (P= 0.01) and an interaction between DM and African American race was found to be signifciant in reduced HAV response (P= 0.04). Conclusion: Because response to both HAV and HBV vaccine alone or in combination are lower than expected in pts with HCV and advanced fibrosis, our data confirm that pts with HCV be vaccinated early in their disease. Although not significant due to small sample size, our data also suggests that response to combination A/B vaccine may increase response to HBV and justifies larger studies to test this hypothesis.