Can hepatitis B vaccination enhance immune response in all patients with chronic liver disease?
Makaleler > Tam Makale · 2004
Yazarlar: Funda ÇETİN, B. Dikici, R. V. Yagci
Alimentary Pharmacology & Therapeutics, Uluslararası, Wos, 2004, cilt 20, ss 247-247
DOI: 10.1111/j.1365-2036.2004.02010.x
Özet
Sirs, We read Reiss and Keeffes’ review article1 with enthusiasm and great benefit. They presented augmented data on hepatitis vaccination in patients with chronic liver disease. They mentioned that hepatitis B vaccination, as opposed to hepatitis B virus (HBV) infection, might invoke resolution of infection in chronic hepatitis C virus (HCV) patients.2 They referred one of their works evaluating the safety of hepatitis B vaccine in patients with chronic HCV infection and they have observed a significant decrease in serum alanine aminotransferase levels when compared with HCV patients with evidence of immunity to HBV who were not immunized.3 They have drawn attention to the evidence of a possible therapeutic benefit of HBV vaccination in chronic HCV infected cases as well as the documented benefit of prevention of acute and chronic HBV infection in the same group of patients. We have evaluated the efficacy of specific HBV vaccination as active immunotherapy in chronic HBV infected children during immunotolerant phase.4 Immunetolerance was defined as high viral load, hepatic activity index of lower than 5 and normal aminotransferase values. Our aim in that study had been to stimulate the insufficient immune response of host against HBV. Therefore, regular vaccination programme with three doses was applied to 43 children and was compared with 31 non-vaccinated cases. Contrary to the authors’ considerations, we have observed no immunological response in any of following parameters in our special group of patients. We concluded that hepatitis B vaccine could not induce immune system to clear HBV in children because of lack of immunological potential. The authors’ assessed resolution in aminotransferases during hepatitis B vaccination in chronic HCV patients indicating an enhancement in host immune responses to antigen of another hepatorophic virus. Induction of envelope antigen specific T cell responses and suppression of serum HBV-DNA load are also documented after HBV vaccination in chronic HBV infected adults.5, 6 However, our clinical observation in paediatric population does not concordate with the adults’ data. The authors confirm the obligation of hepatitis A and B vaccination in patients with chronic liver disease and consider the therapeutical efficacy of hepatitis B vaccination. However; different vaccination protocols should be considered to better induce immune response in immuntolerant children with chronic HBV infection.