Good response to HBsAg vaccine in dialysis patients is associated with high CD4+/CD8+ ratio

• DOI: 10.1007/s11255-011-0043-6
• Publication Date: 2011-08-01T09:33:48Z
• Authors: Funda Sari; Hulya Taskapan
• Keywords: Adult; Clonal Anergy; Male; Hepatitis B virus; Hepatitis B Surface Antigens; CD4-CD8 Ratio; Middle Aged; Antibodies, Viral; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Hepatitis B Vaccines; Renal Insufficiency, Chronic; Aged; Candida; Skin Tests

Chronic renal failure is accompanied by various abnormalities of innate and acquired, cellular and humoral immunity. We aimed to investigate whether positive Candida skin test results, CD4+ and CD8+, before the first dose of vaccination could be a predictor for antibody response to hepatitis B vaccination and the relation of these parameters with hepatitis B antibody levels 1 month after the last dose of vaccination.The present study was carried out in 57 dialysis patients. All patients received recombinant hepatitis B vaccine (40 μg) given intramuscularly in the deltoid muscle in a four-dose schedule at 0, 1, 2, and 6 months. Candida skin test and lymphocyte subsets (CD4+ and CD8+) were determined before the first dose of vaccination and 1 month after the fourth inoculation of hepatitis B vaccine.Ten patients (17.5%) were non-responders (HBsAb < 10 IU/L), while 47 patients (82.5%) were responders (HBsAb ≥ 10 IU/L). However, 29 patients (50.9%) were weak responders (HBsAb:10-100 IU/L), 18 patients (31.6%) good responders (HBsAb > 100 IU/L), which was determined 1 month after the fourth dose of vaccination. Thirty-nine patients (68.4%) and 44 patients (77.2%) were anergic to Candida skin test before the first dose and 1 month after fourth inoculation of hepatitis B vaccine, respectively. There was no relationship between Candida skin test and response to hepatitis B vaccination. Mean age was lower, and CD4+/CD8+ ratio measured both before and after vaccination was higher in good responders compared with that of weak responders and that of non-responders. Females were better responders than males.High skin test anergy rate and low seroconversion rate after hepatitis B vaccination are important problems in patients on dialysis. Females, younger patients, and patients with higher CD4+/CD8+ ratio have better HBsAb antibody response to hepatitis B vaccination.