Abstract
Abstract
Background: Chronic hepatitis B virus (HBV) infection remains a global health problem and a leading cause of cirrhosis and hepatocellular carcinoma. Dialysis patients have an increased risk of contracting HBV due to shared dialysis machines, use of blood products and arteriovenous fistula or graft needling. The efficacy of HBV vaccination series is reduced in dialysis patients. The efficacy of this intervention needs to be better studied in South Africa.
Methods: All patients undergoing dialysis at a large urban hospital who had received the HBV vaccine at least 6 months prior had the following variables documented: demographics; aetiology of end stage kidney disease (ESKD); mode of dialysis; history of smoking or immunosuppression; body mass index (BMI) and serology (HBV, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) status). The prevalence of non-response to the HBV vaccination and predictors of non-response in these patients was determined.
Results: 129 patients were included with a median age of 45 years, 52.7% were male, 14.3% were HIV positive and 2.3% were HCV infected. 21% of patients had a BMI greater than 30kg/m². 8.5% of patients received immunosuppression. The commonest cause of ESKD was ‘unknown aetiology’ (39.5%) followed by hypertension (31.0%). 55% were receiving haemodialysis and 45% peritoneal dialysis. 21.7% of the cohort had not adequately responded to the HBV vaccine. Immunosuppression was associated with poorer HBV vaccine response (p = 0.0498); no other variables predicted seroconversion.
Conclusion: This study from a large urban hospital in Johannesburg, South Africa, demonstrated a seroconversion rate similar to international studies. Only the use of immunosuppression showed a lower odds ratio of a successful vaccination.