Response to Hepatitis A and B Vaccine Alone or in Combination in Patients with Chronic Hepatitis C Virus and Advanced Fibrosis
Response to Hepatitis A and B Vaccine Alone or in Combination in Patients with Chronic Hepatitis C Virus and Advanced Fibrosis
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DOI：
10.1007/s10620-009-0867-4
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发表时间：
2009-09-01
影响因子：
3.1
通讯作者：
Sterling, Richard K.
中科院分区：
文献类型：
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作者：
Kramer, Erik Seth;Hofmann, Charlotte;Sterling, Richard K.
晚期纤维化患者如果发生甲型肝炎(HAV)或乙肝(乙肝)病毒的急性感染，严重后果的风险会增加。目前尚无甲型肝炎病毒/乙肝病毒联合接种对晚期纤维化患者的疗效数据。我们的目的是评估单独或联合使用甲肝和乙肝疫苗对慢性丙型肝炎(丙型肝炎)和晚期纤维化患者的反应，并评估在患者接受聚乙二醇干扰素治疗慢性丙型肝炎的同时使用疫苗的影响。在这项对晚期纤维化患者(Ishak 3-6)进行的前瞻性研究中，那些没有血清学证据的患者接种了Havrix(A(R))HAV、Engerix(A(R))乙肝疫苗或TWINRIXA(R)HAV/乙肝病毒组合疫苗，其反应被定义为产生抗HAV或抗乙肝病毒表面抗体。在162名符合条件的患者中，既往接触甲型肝炎病毒和乙肝病毒的流行率分别为30%和18%。在84名接种疫苗的患者中，38%接受了Havrix，14%接受了Engerix，48%接受了TWINRIXA(R)。接受Havrix(A(R))治疗的患者对甲型肝炎疫苗的反应率为75%，而接受TWINRIXA(R)治疗的患者对甲型肝炎疫苗的反应率为78%。相比之下，接受Engerix(A(R))的患者对接种乙肝疫苗的反应率为42%，而接种TWINRIXA(R)的患者对乙肝疫苗的反应率为60%(差异18.3%；OR 0.29；95%CI：0.57-7.79)。糖尿病是乙肝病毒应答降低的唯一危险因素(P=0.01)。在丙型肝炎和晚期纤维化患者中，单独或联合应用甲肝和乙肝疫苗时的应答低于预期，特别是在糖尿病患者中。观察到，与A/B组合疫苗相比，单独接种时，乙肝疫苗应答率的下降幅度略低，这表明联合疫苗的接种可能会增强对乙肝的接种反应。
Patients with advanced fibrosis are at increased risk of severe outcomes if they develop acute infection with hepatitis A (HAV) or hepatitis B (HBV) viruses. There are no data on the efficacy of combined HAV/HBV vaccination in patients with advanced fibrosis. Our aim was to evaluate the response to the HAV and HBV vaccine alone or in combination for patients with chronic hepatitis C (HCV) and advanced fibrosis and to evaluate the impact of administering the vaccine while patients were receiving peginterferon for treatment of chronic HCV. In this prospective study of patients with advanced fibrosis (Ishak 3-6), those without serologic evidence of prior exposure were vaccinated with either Havrix(A (R)) HAV, Engerix(A (R)) HBV, or the TWINRIXA (R) HAV/HBV combination vaccine as appropriate, and response was defined as the development of anti-HAV or anti-HBV surface antibodies. Of the 162 eligible patients, the prevalence of prior exposure to HAV and HBV was 30 and 18%, respectively. Of the 84 patients vaccinated, 38% received Havrix, 14% Engerix, and 48% TWINRIXA (R). The response to the HAV vaccine was 75% in those receiving Havrix(A (R)) compared to 78% receiving TWINRIXA (R). In contrast, the response to HBV vaccination was 42% in patients receiving Engerix(A (R)) compared to 60% in those vaccinated with TWINRIXA (R) (difference 18.3%; OR 0.29; 95% CI: 0.57-7.79). The presence of diabetes was the only risk factor identified for reduced HBV response (P = 0.01). Responses to both HAV and HBV vaccines when administered alone or in combination were lower than expected in patients with HCV and advanced fibrosis, especially in those with diabetes. The observation that the decline in HBV vaccine response was somewhat lower when this was administered alone as opposed to the combination A/B vaccine suggests that the administration of a combination vaccine may enhance the vaccination response to HBV.