Hepatitis C virus and the immunological response to hepatitis B virus vaccine in dialysis patients: meta-analysis of clinical studies

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Hepatitis C virus and the immunological response to hepatitis B virus vaccine in

dialysis patients: meta-analysis of clinical studies

F. Fabrizi1,

V. Dixit2,

P. 2,

P. Messa1

Article first published online: 4 APR 2011

DOI: 10.1111/j.1365-2893.2011.01459.x

© 2011 Blackwell Publishing Ltd

Issue

Journal of Viral Hepatitis

Early View (Online Version of Record published before inclusion in an issue)

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2011.01459.x/abstract

Summary.  It is well known that the seroconversion rate of patients following

hepatitis B virus (HBV) vaccination is lower in uraemic than healthy subjects. A

variety of inherited or acquired factors have been implicated in this diminished

response, and the high prevalence of hepatitis C virus (HCV) infection among

patients on maintenance dialysis has been suggested to play a role. However, the

impact of HCV on the immune response to HB vaccine in patients receiving

long-term dialysis is not entirely understood. Here, we evaluate the influence

of HCV infection on the immunological response to HBV vaccine in dialysis

population by performing a systematic review of the literature with a

meta-analysis of clinical studies.We used the random-effects model of

DerSimonian and Laird with heterogeneity and sensitivity analyses. The end-point

of interest was the rate of patients showing seroprotective anti-hepatitis B

titres at completion of HBV vaccine schedule among HCV-positive versus

HCV-negative patients on chronic dialysis. We identified eight studies involving

520 unique patients on long-term dialysis. Aggregation of study results did not

show a significant decrease in response rates among HCV-infected versus

noninfected patients [pooled odds ratio = 0.621 (95% CI, 0.285; 1.353)]. The

P-value was 0.007 for our test of study heterogeneity. Stratified analysis in

various subgroups of interest did not meaningfully change our results. Our

meta-analysis showed no association between immunological response to hepatitis

B vaccine and HCV infection in individuals on long-term dialysis. These results

support the use of recombinant vaccine against hepatitis B in patients on

regular dialysis with HCV infection.