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      Granulocyte-Macrophage Colony-Stimulating Factor as an Adjuvant to Hepatitis B Vaccination in Maintenance Hemodialysis Patients

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          Patients on maintenance hemodialysis (HD) have poor seroconversion rate after hepatitis B vaccination. The present study was designed to test the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjuvant to hepatitis B vaccination for improving seroconversion rate in maintenance HD patients. Twelve chronic HD patients were randomly assigned to receive either hepatitis B vaccination alone or hepatitis B vaccination 24 h after 1 dose of GM-CSF for primary immunization. A group of 16 chronic HD patients who had not seroconverted after a standard two-dose hepatitis B vaccination were randomly assigned either to a booster dose of hepatitis B vaccine alone or a booster dose given 24 h after one dose of GM-CSF. In the primary immunization group only 2 of 6 patients (33%) who had received vaccination alone, versus 5 of 6 patients (83%) who had received hepatitis B vaccine after one dose of GM-CSF, developed seroprotective antibody titers. Moreover, seroprotective antibody titers (IU/ml) were significantly higher in the latter group (275 ± 286.5 vs. 14 ± 22, p < 0.05). In patients who had not seroconverted with prior hepatitis B vaccination, GM-CSF adjuvant therapy significantly increased the seroconversion rate versus booster dose alone (87.5 vs. 25%, respectively, p < 0.02), with significantly higher seroprotective antibody titers (84 ± 80 vs. 19 ± 33 IU/ml, respectively, p < 0.05). These findings suggest that administration of one dose of GM-CSF, as adjuvant therapy, prior to primary or booster dose hepatitis B vaccination may significantly increase seroconversion rate and seroprotective antibody titers in chronic HD patients.

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          Duration of hepatitis B surface antigenemia (HBs Ag) in hemodialysis patients.

          Follow-up studies were done on 231 hemodialysis patients during a period of from one to 48 months to determine the natural history of hepatitis B surface antigenemia (HBs Ag). Of those studied, 113 (49%) exhibited HBs Ag. The probability of remaining HBs Ag positive over the mean follow-up period of 14.4 months was 62%. All of the 38 patients whose HBs Ag reverted to negative did so within ten months. Those patients whose HBs Ag reverted to negative had SGOT levels that were less frequently elevated than the patients with persistent antigenemia. Of hemodialysis patients with HBs Ag, 60% showed e antigen (HBe Ag).

            Author and article information

            Am J Nephrol
            American Journal of Nephrology
            S. Karger AG
            February 2000
            13 January 2000
            : 20
            : 1
            : 53-56
            aDivision of Nephrology, Manipal Hospital, Bangalore, India; bDivision of Nephrology, Saint Louis University School of Medicine, St. Louis, Mo., USA
            13556 Am J Nephrol 2000;20:53–56
            © 2000 S. Karger AG, Basel

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            Tables: 2, References: 24, Pages: 4
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