Response to hepatitis B vaccination in adult patients with cirrhosis of liver- A real world scenario

Abstract

Background and Aim: We aimed to determine response rates to hepatitis B vaccination and its determinants in adult patients with cirrhosis of liver. Methods: This prospective study was done over a period of three years from 2019-2021. All adult patients (>18 years) with cirrhosis of liver were screened for HBsAg, anti HBc and anti HBs. Those who were negative for all were advised vaccination. For vaccine naïve patients, dose of 20 mcg intramuscular in deltoid region was administered at 0, 1 and 6 months. For those with prior history of vaccination but negative anti HBs titres, dose of 40 mcg was used at 0, 1 and 6 months. We excluded patients who were known HBs Ag positive, on oral antiviral drugs and who did not complete the recommended vaccination. Anti HBs titres were measured 2 months after completion of vaccination. Patients with anti HBs titres >10 were considered responders and those with titres <10 were labelled as non-responders. Baseline demographic parameters, anthropometry, Model of End stage liver disease (MELD) score and history of prior vaccination were compared between the two groups. Results: A total of 678 patients with cirrhosis were seen over the study period. Seventy-two were newly found to be HBs Ag +/ anti HBc + and 165 were detected to be anti HBs +. A total of 277 cases did not complete vaccination or were lost to follow up. The study cohort included 164 patients- median age 43 (18-68) years and 67% males. On follow up at 2 months after last dose of vaccination, 103 (62.8%) had anti HBs titre >10 IU/L. Non responders were significantly older than responders (48 vs 41 years, p 0.01). Conclusions: The response rate to hepatitis B vaccination in cirrhotics is 62.8%. Older patients are more likely to be non-responders.