Efficacy of repeated high-dose hepatitis B vaccine (80 microg) in patients

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J Viral Hepat. 2006 Apr;13(4):217-21.

Efficacy of repeated high-dose hepatitis B vaccine (80 microg) in patients

with chronic liver disease.

Aziz A, Aziz S, Li DS, L, Leone N, Kennedy M, Dhillon S, Van Thiel

DH.

Division of Gastroenterology, Nutrition and Hepatology, Department of

Medicine, Loyola University Medical Center, Maywood, IL 60153, USA.

aziz4u@...

Patients with chronic liver disease (CLD) respond poorly to standard

hepatitis B (HBV) vaccine given as sequential 20 microg IM shots because of

an overall impaired immune response. Many of these patients go on to liver

transplantation and are at risk of acquiring recurrent or de novo HBV

infection. To evaluate the efficacy and safety of high-dose (80 microg) IM

HBV vaccination in patients with CLD who had previously failed to respond to

a standard three-dose schedule of 40 microg IM vaccine given monthly. A

retrospective review was undertaken at our institution of 79 patients with

CLD who were treated with high-dose (80 microg) HBV vaccinations. All had

previously failed a three-dose course of 40 microg HBV vaccine. An HBV

vaccine response was defined as an anti-HBs titer greater than 100 mIU/ml.

Liver enzymes, creatinine, age, prothrombin time, total vaccine dose, and

MELD score were recorded. No adverse events were reported. Seventy-two per

cent (57/79) of the subjects had an adequate response after receiving a mean

total dose of 220 mug vaccine (range 80-800 microg). Twenty-eight per cent

(22/79) of the subjects did not respond after receiving a mean total dose of

420 microg vaccine (range 240-720 microg). Non-responders had more severe

hepatic disease defined as a higher mean total bilirubin level (p = 0.003)

and a lower mean albumin level (p < 0.05). Age, prothrombin time, MELD

score, and creatinine were not statistically significant between the

responders and non-responders. Repeated high-dose (80 microg) HBV

vaccination, in patients who do not respond to standard HBV vaccine doses,

is safe and effective in the majority of patients with CLD.

PMID: 16611186 [PubMed - in process]

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