title: Good response to HBsAg vaccine in dialysis patients is associated with high CD4+/CD8+ ratio.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Nephrology, Antalya Education and Research Hospital, Ministry of Health, Antalya, Turkey. fundasari@ymail.com
authors.forename: Funda
authors.initials: F
authors.lastname: Sari
authors.forename: Hulya
authors.initials: H
authors.lastname: Taskapan
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D016516:CD4-CD8 Ratio; D002175:Candida / Q000276:immunology; D017635:Clonal Anergy; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000276:immunology*; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines