IMPAIRED RESPONSE TO RECOMBINANT-DNA HEPATITIS-B VACCINE IN PATIENTS WITH ALCOHOLIC LIVER-DISEASE

Sixty patients with biopsy-diagnosed alcoholic liver disease were vaccinated with a yeast-derived recombinant DNA hepatitis B vaccine. Fifty-three patients (36 cirrhotics) completed a full course of three intradeltoid injections with 20-mu-g of vaccine using a 0,1,6-month schedule. Titres of hepatitis B surface antibody (anti-HB(s)) were measured by radioimmunoassay 1 month after the final injection, and patients were classified as non-responders (< 10u/l) or responders (> 10u/l). Twenty cirrhotics (55%) and 13 non-cirrhotics (76%) responded to vaccination with geometric mean titres to anti-HB(s) of 62.7 u/l and 73.9 u/l, respectively. Cirrhotic non-responders had significantly higher pre-vaccination levels of aspartate aminotransferase, gamma glutamyl transpeptidase and bilirubin, and a lower level of albumin than responders. They also consumed a significantly greater daily amount of alcohol. No similar changes were seen in the non-cirrhotics. Eighteen non-responders (15 cirrhotics) received a fourth vaccination at 12 months, and seven of these developed anti-HB(s) titres greater than 10 u/l 4-6 weeks after injection. Patients with alcoholic liver disease, particularly cirrhotics, have an impaired response to hepatitis B vaccination, which can in some cases be improved by administering a booster injection at 12 months. In cirrhotics, poor immunogenicity may be related to continued alcohol consumption and active liver disease.