HBV vaccine improves survival of patients with chronic liver disease

Vaccination against hepatitis B virus (HBV) results in meaningful improvements in survival among patients with different kinds of chronic liver diseases, suggests a study presented at AASLD 2023.

“Our results demonstrated that vaccinated patients with different kinds of chronic liver diseases generally had significantly better survival when the use of hepatitis B surface antigen vaccine was verified,” said the researchers, led by Andreas Teufel from the Medical Faculty Mannheim, Heidelberg University, Germany.

“Hepatitis B vaccine has proven highly successful in preventing HBV infection and reducing consequential hepatitis B-related disease burden in the countries where vaccination has been implemented. However, few studies have reported the impacts of the hepatitis B vaccination in overall survival, particularly on patients with chronic liver disease other than chronic hepatitis B,” they noted.

Teufel and colleagues assessed a total of 57,306 patients with chronic liver disease between 2000 and 2020 through the Observational Health Data Sciences and Informatics (OHDSI) consortium to examine the efficacy of the hepatitis B vaccine on this cohort.

Of the patients with chronic liver disease, 1,601 (2.79 percent) had been vaccinated against HBV. Vaccinated patients demonstrated a significantly improved survival (p=0.000), as did those with liver cirrhosis (p=0.000). [AASLD 2023, abstract 1341-C]

Subgroup analysis confirmed the significant benefits derived from HBV vaccination (p=0.0001), particularly in patients with chronic hepatitis C (p=0.000), chronic nonalcoholic liver disease (p=0.0001), or both alcoholic and nonalcoholic-induced cirrhosis (p=0.0001 for both). No differences were observed in these benefits between genders.

“However, as 97.21 percent (55,706/57,306) of the population were not reported as immunized, further efforts to improve the quality and comprehensiveness of medical records in chronic liver disease patients must be implemented,” the investigators said.

Liver cirrhosis

An earlier study involving patients with liver cirrhosis reported lower seroprotection rates even after completing the HBV vaccination series. The authors identified 11 studies after searching Medline. Overall, 961 participants were assessed, and variations were noted in the dose of the vaccine and the schedule of the vaccination. [Rev Med Virol 2017;doi:10.1002/rmv.1942]

Among cirrhotic patients, the response rates to the HBV vaccination ranged from a low of 16 percent to as high as 87 percent, irrespective of the number and dose of vaccine. Those who received the standard dose of vaccination achieved seroprotection rates ranging from 16 percent to 79 percent (mean response rate, 38 percent), while those who received a double dose had better seroprotection at 26 percent to 87 percent (mean response rate, 53 percent). Overall, the mean response rate to the HBV vaccination was 47 percent. [Rev Med Virol 2017;doi:10.1002/rmv.1942]

“Several strategies have tried to improve the immunogenicity,” the authors said. “[H]owever, there is a great need for additional studies to further explore the immune response in relation to poor vaccination responsiveness confounding factors, novel strategies to improve immunogenicity, and the immune mechanism underlying the differences in response rates to HBV vaccination,” the authors said.