Immunogenicity of hepatitis A vaccination in decompensated cirrhotic patients

Hepatitis A virus (HAV) vaccination is recommended in chronic liver disease because of an increased morbidity and mortality associated with HAV superi nfection. However, data regarding the efficacy of HAV vaccination in patien ts with advanced chronic liver disease is limited. We assessed the efficacy of a standard HAV vaccination schedule in decompensated chronic liver dise ase in comparison with compensated disease and defined clinical predictors associated with seroconversion. Eighty-four anti-HAV antibody-negative pati ents, 49 with compensated liver disease, and 35 with decompensated disease were enrolled. Seroconversion was measured by qualitative and quantitative anti-HAV antibody measurements 1 month after each vaccine dose, and univari ate/multivariate analysis was performed to define clinical predictors assoc iated with seroconversion. One month after the primary dose, 71.4% of patie nts with compensated liver disease had detectable anti-HAV antibody compare d with 37.1% with decompensated liver disease (P < .05). One month after th e booster dose, 98% of compensated patients seroconverted compared with 65. 7% with decompensated disease (P < .05). The median serum antibody concentr ation in compensated liver disease was 76.4 mIU/mL at month 1 and 327.91 mI U/mL at month 7 compared with 20.0 mIU/mL and 102.57 mIU/mL, respectively, in decompensated disease. On multivariate analysis, Child-Pugh class was th e only factor predicting response to vaccination. Seroconversion after HAV vaccination was significantly less common in decompensated liver disease an d the presence of advanced disease (Child-Pugh class B/C) predicted a lower response rate. These findings indicate that the response to HAV vaccinatio n in chronic liver disease is optimal when targeted to patients before the development of hepatic decompensation.