Elefsiniotis Ioannis-S, Vezali Elena, Kamposioras Konstantinos, Pantazis Konstantinos-D, Tontorova Radostina, Ketikoglou Ioannis, Moulakakis Antonios, Saroglou George
Department of Internal Medicine, Hepatology Unit, Hippokration Hospital of Athens, Athens, Greece.
World J Gastroenterol. 2006 Jul 21;12(27):4420-4. doi: 10.3748/wjg.v12.i27.4420.
To retrospectively evaluate the vaccination-induced anti-HBs seroconversion rates in treatment-naive and treatment-experienced chronic hepatitis C (CHC) patients. Also to prospectively evaluate the seroconversion rates in CHC patients during pegylated interferon (PEG) plus ribavirin (RIB) treatment.
Seventy treatment-naive CHC patients (group A), 22 sustained virological responders-SVR following interferon (IFN) plus RIB treatment CHC patients (group B) and 121 healthy subjects (group C) had been participated in the same HBV vaccination schedule (20 microg, 0-1-6 mo). Seroconversion was considered if anti-HBs levels were above 10 mIU/mL within 3 mo following the third dose of the vaccine. Moreover, we prospectively selected 30 non-cirrhotic CHC patients and evaluated them for the efficacy of the same vaccine schedule randomizing them in two groups: Group-1, 15 CHC patients received the first dose of the vaccine in parallel with the initiation of PEG plus RIB treatment and Group-2, 15 patients received the same vaccination schedule without concomitant treatment. Determination of anti-HBs was performed at mo 1, 2, and 7. Statistical analysis of data was based on ANOVA student's t-test and chi-square analysis (P < 0.05).
Fifty-eight of 70 group A patients (82.85%), 20/22 group B (90.9%) and 112/121 healthy subjects (92.56%) had been seroconverted. The seroconversion rates were significantly higher in the control group than in treatment-naive CHC patients (P = 0.04). The corresponding rates were comparable between group A and group B CHC patients (P = 0.38). The vast majority of non-responders (10/14, 71.43%) had been infected by genotype-1 of HCV. The seroconversion rates were comparable between group 1 and 2 CHC patients at mo 1 (20% versus 26.7%, P = 0.67), mo 2 (46.7% vs 60%, P = 0.46) and mo 7 (86.7% versus 93.3%, P = 0.54) of follow-up.
The immunogenicity of HBV vaccine seems to be lower in CHC patients compared to healthy subjects. SVR following IFN plus RIB treatment does not affect the antibody response to HBV vaccine. Infection by genotype-1 seems to negatively influence the seroconversion rates. Vaccination against HBV during PEG plus RIB combination treatment is not beneficial in terms of anti-HBs seroconversion rates.
回顾性评估初治和经治的慢性丙型肝炎（CHC）患者接种疫苗后抗-HBs血清转化率。同时前瞻性评估聚乙二醇干扰素（PEG）联合利巴韦林（RIB）治疗期间CHC患者的血清转化率。
70例初治CHC患者（A组）、22例接受干扰素（IFN）联合RIB治疗后获得持续病毒学应答（SVR）的CHC患者（B组）和121例健康受试者（C组）采用相同的乙肝疫苗接种方案（20μg，0、1、6月）。第三剂疫苗接种后3个月内抗-HBs水平高于10mIU/mL则视为血清转化。此外，我们前瞻性选择30例非肝硬化CHC患者，将其随机分为两组评估相同疫苗接种方案的疗效：第1组，15例CHC患者在开始PEG联合RIB治疗的同时接种第一剂疫苗；第2组，15例患者接受相同的疫苗接种方案但不进行联合治疗。在第1、2和7个月测定抗-HBs。数据的统计分析基于方差分析、学生t检验和卡方分析（P<0.05）。
A组70例患者中有58例（82.85%）、B组22例中有20例（90.9%）、健康受试者121例中有112例（92.56%）实现血清转化。对照组的血清转化率显著高于初治CHC患者（P=0.04）。A组和B组CHC患者的相应比率相当（P=0.38）。绝大多数无应答者（10/14，71.43%）感染的是HCV基因1型。在随访的第1个月（20%对26.7%，P=0.67）、第2个月（46.7%对60%，P=0.46）和第7个月（86.7%对93.3%，P=0.54），第1组和第2组CHC患者的血清转化率相当。
与健康受试者相比，CHC患者中乙肝疫苗的免疫原性似乎较低。IFN联合RIB治疗后的SVR不影响对乙肝疫苗的抗体应答。基因1型感染似乎对血清转化率有负面影响。在PEG联合RIB联合治疗期间接种乙肝疫苗在抗-HBs血清转化率方面并无益处。
