Response to Hepatitis B Vaccine in Egyptian Chronic Hepatitis C Patients

Abstract

Background: Egypt is cursed with 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 vaccination and risk factors for weak response are not clearly identified. Aim: To assess response to hepatitis B vaccination in CHC patients and identify predictors of weak response. Methods: This prospective study included 112 consecutive adults, treatment-naive patients with CHC (cases group) and 54 non HCV subjects (control group). Demographic and laboratory variables including HCV-viral load and anti schistosomal antibody beside histopathological examination were all collected. Three doses (0, 1 and 6 months) of HBV-vaccine (Euvax B, LG Life Sciences, Korea) were given and hepatitis B surface antibody (HBs-Ab) titre was evaluated 1.5-2 months after the 3rd dose. Result: Out of 112 patients with CHC, 5 (4.5%) had HBs Ab titre less than 10 IU, 20 (17.9%) had less than 100 IU, and 50 (44.6%) had more than 1000 IU. In comparison, out of 54 controls, one (1.9%) had less than 10 IU, 2 (3.8%) had less than 100 IU, and 41 (75.9%) had more than 1000 (P = 0.001). CHC patients had highly significant lower mean antibody titre than controls (P < 0.001). In univariate regression analysis, HBs Ab titre was negatively associated with age (P < 0.001), ALT (P = 0.03), AST (P = 0.03), FIB4 score (P = 0.008), and antischistosomal antibody titre (P = 0.007) and positively associated with platelet count (P = 0.01). There was no association with gender, body mass index, viral load or other variables (including METAVIR grade or stage). Multivariate regression analysis in CHC patients showed that age (P = 0.02) and antischistosomal antibody titre (P = 0.04) were the independent predictors for HBs Ab titre response. Conclusion: CHC patients have a significantly weak response to HBV-vaccine, particularly those with older age and schistosomiasis.