New Page 2

Afro-Egypt J Infect  Endem  Dis  2017 December ; 7(4):258

Response to Hepatitis B Vaccine in Egyptian Chronic Hepatitis C Patients

Ebada Said1, Mohamed Metwally1, Dalia Abd El Hassib2, Rasha Elsawi3and Mohamed Atta1&4

Departments of Hepatology, Gastroenterology and Infectious Diseases1, Benha University,Clinical and Chemical pathology2, Benha University, Pathology3, Benha University and Medicine4, Rabigh Faculty of Medicine, King Abdulaziz University, Kingdom of Saudi Arabia



Background and study aim: Egypt unfortunately has the highest worldwide prevalence of chronic hepatitis C (CHC). Patients with CHC are advised to be vaccinated against hepatitis B virus (HBV) infection. Response to hepatitis B vaccination and risk factors for a weak response are not clearly defined.. The aim of this study is to assess the response to hepatitis B vaccination in CHC patients and identify predictors of a weak response.

Patients and Methods: This prospective study included 112 consecutive adult, treatment- naive, CHC patients (cases group) and 54 non-hepatitis C virus (HCV) subjects (control group). Demographic and laboratory variables including HCV-viral load, schistosomal antibody (Ab) titre, and histopathological examination of liver biopsy were assessed. Three intramuscular 20 µg doses (given at 0, 1 & 6 months) of HBV-vaccine (Euvax-B, Korea) were administered, and hepatitis B surface antibody (HBsAb) titres were evaluated 6 – 8 weeks after the 3rd dose.

Results: Out of 112 CHC patients, five (4.5%) had HBsAb titres of <10 mIU/mL, 20 (17.9%) had <100, and 50 (44.6%) had titres of >1000. In comparison, out of 54 controls, one (1.9%) had a titre of <10 mIU/mL, 2 (3.8%) had <100, and 41 (75.9%) had >1000 (P= 0.001). CHC patients had highly significant lower mean Ab titres than controls (P<0.001). In a univariate regression analysis, HBsAb titre was negatively associated with age (P<0.001), ALT (P=0.03), AST (P=0.03), FIB-4 score (P=0.008) and schistosomal Ab titre (P= 0.007) and positively associated with platelet count (P=0.01). There was no association with gender, BMI, viral load or other variables (including METAVIR grade or stage). A multivariate regression analysis in CHC patients showed that age (P= 0.02) and schistosomal Ab titre (P= 0.04) were independent predictors of HBsAb titre response.

Conclusions: CHC patients, particularly of older age or with schistosomiasis, have a significantly weakened  response to the HBV-vaccine.