title: Levamisole usage as an adjuvant to hepatitis B vaccine in hemodialysis patients, yes or no?
abstract: BACKGROUND
  Hepatitis B virus (HBV) infection is much more common in hemodialysis patients than the general population. These patients have an impaired immune response to HBV vaccination; to that end there are certain studies that have evaluated levamisole as an immunomodulator agent improving HBV vaccination response rate in hemodialysis patients.
  
  
  OBJECTIVE
  In the current review, we have assembled all of the results to determine whether lavamisole is of value as an adjuvant to HBV vaccination in hemodialysis patients.
  
  
  METHODS
  Science Direct (Elsevier), ProQuest, Springer, MD Consult, BMJ Journals, Pubmed and Wiley were searched for levamisole application to HBV vaccination in hemodialysis patients. All studies revealed a seroconversion response level between levamisole plus HBV vaccine versus HBV vaccine alone.
  
  
  RESULTS
  From 10 relevant studies, 5 studies fulfilled our inclusion criteria. Three of them suggested the significant benefit of adding levamisole to the HBV vaccine to increase augment seroprotection level in hemodialysis patients. Another study reported a decrease in seroprotection level and another study showed no significant difference caused by levamisole administration.
  
  
  CONCLUSIONS
  Due to the limited number of studies evaluated, it is challenging to perform a definite decision about routinely administering levamisole in addition to the HBV vaccine for all hemodialysis patients. However, it does seem reasonable to recommend administration of levamisole for impaired immune response patients.
authors.affiliation: Department of Nephrology, Faculty of Medicine, Zahedan Medical University, Zahedan, IR Iran.
authors.forename: Houshang
authors.initials: H
authors.lastname: Sanadgol
keywords: Hemodialysis Units, Hospital; Hepatitis B; Vaccination