***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this work was to evaluate in a case – control study the immunogenicity of a recombinant hepatitis B virus ( HBV ) vaccine in patients with chronic hepatitis C. Seventy-seven patients with histologically proven chronic hepatitis C without cirrhosis were included in a prospect i ve trial and matched for sex and age to 231 healthy adult subjects .  Recombinant HBV vaccine was administered at a dose of 20 μg at months 0 , 1 and 2 . The definition of ‘ responder to vaccination ’ was anti-HBs titre > 10 mIU/ml after the three injections . Forty-nine ( 63.6 % ) chronic hepatitis C patients were responders to vaccination , compared with 217 ( 93.9 % ) controls ( P < 0.0001 ) . After the three injections , anti-HBs titres were 156 ± 260 and 615 ± 435 mIU/ml ( P < 0.0001 ) , respectively . Chronic hepatitis C patients who were non-responders to vaccination had significantly higher viral load than responders to vaccination . Moreover , a negative correlation was observed between viral load and anti-HBs concentration ( r = –0.36 , P = 0.003 ) . No significant side effects were observed . There was no effect of vaccination on alanine aminotransferase ( ALT ) levels and hepatitis C virus ( HCV ) viral load during or after vaccination . In multivariate analysis , the main predictive factors of response to HBV vaccine  were absence of anti-HCV antibodies ( OR = 7.65 , P < 0.0001 ) , weight < 75 kg ( OR = 1.99 , P < 0.035 ) , and age < 50 years ( OR = 1.58 , P < 0.082 ) . Our results suggest that viral load seems to negatively influence the response to HBV vaccine Vaccination for hepatitis B virus ( HBV ) in the setting of hepatitis C virus ( HCV ) infection is recommended , but responses to vaccination are blunted when compared to uninfected population s. The mechanism for this failure of immune response in HCV-infected subjects remains unknown but is thought to be a result of lymphocyte dysfunction during chronic viral infection . We have recently demonstrated that PD-1 , a novel negative immunomodulator for T cell receptor ( TCR ) signaling , is involved in T and B lymphocyte dysregulation during chronic HCV infection . In this report , we further investigated the role of the PD-1 pathway in regulation of CD4(+ ) T cell responses to HBV vaccination in HCV-infected individuals . In a prospect i ve HCV infected cohort , a poor response rate to HBV vaccination  as assayed by seroconversion was observed in HCV-infected subjects ( 53 % ) , while a high response rate was observed in healthy or spontaneously HCV-resolved individuals ( 94 % ) . CD4(+ ) T cell responses to ex vivo stimulations of anti-CD3/CD28 antibodies or hepatitis B surface antigen ( HBsAg ) were found to be lower in HBV vaccine non-responders compared to those responders in HCV-infected individuals who had received a series of HBV immunizations . PD-1 expression on CD4(+ ) T cells was detected at relatively higher levels in these HBV vaccine non-responders than those who responded , and this was inversely associated with the cell activation status . Importantly , blocking the PD-1 pathway improved T cell activation and proliferation in response to ex vivo HBsAg or anti-CD3/CD28 stimulation in HBV vaccine non-responders . These results suggest that PD-1 signaling may be involved in impairing CD4(+ ) T cell responses to HBV vaccination in subjects with HCV infection , and raise the possibility that blocking this negative signaling pathway might improve success rates of immunization in the setting of chronic viral infection AIM To retrospectively evaluate the vaccination-induced anti-HBs seroconversion rates in treatment-naive and treatment-experienced chronic hepatitis C ( CHC ) patients . Also to prospect ively evaluate the seroconversion rates in CHC patients during  pegylated interferon ( PEG ) plus ribavirin ( RIB ) treatment . METHODS Seventy treatment-naive CHC patients ( group A ) , 22 sustained virological responders-SVR following interferon ( IFN ) plus RIB treatment CHC patients ( group B ) and 121 healthy subjects ( group C ) had been participated in the same HBV vaccination schedule ( 20 microg , 0 - 1 - 6 mo ) . Seroconversion was considered if anti-HBs levels were above 10 mIU/mL within 3 mo following the third dose of the vaccine . Moreover , we prospect ively selected 30 non-cirrhotic CHC patients and evaluated them for the efficacy of the same vaccine schedule r and omizing them in two groups : Group-1 , 15 CHC patients received the first dose of the vaccine in parallel with the initiation of PEG plus RIB treatment and Group-2 , 15 patients received the same vaccination schedule without concomitant treatment .  Determination of anti-HBs was performed at mo 1 , 2 , and 7 . Statistical analysis of data was based on ANOVA student 's t-test and chi-square analysis ( P < 0.05 ) . RESULTS Fifty-eight of 70 group A patients ( 82.85 % ) , 20/22 group B ( 90.9 % ) and 112/121 healthy subjects ( 92.56 % ) had been seroconverted . The seroconversion rates were significantly higher in the control group than in treatment-naive CHC patients ( P = 0.04 ) . The corresponding rates were comparable between group A and group B CHC patients ( P = 0.38 ) . The vast majority of non-responders ( 10/14 , 71.43 % ) had been infected by genotype-1 of HCV . The seroconversion rates were comparable between group 1 and 2 CHC patients at mo 1 ( 20 % versus 26.7 % , P = 0.67 ) , mo 2 ( 46.7 % vs 60 % , P = 0.46 ) and mo 7 ( 86.7 % versus 93.3 % , P = 0.54 ) of follow-up . CONCLUSION The immunogenicity of HBV vaccine seems to be lower in CHC patients compared to healthy subjects . SVR following IFN plus RIB treatment does not affect the antibody response to HBV vaccine . Infection by genotype-1 seems to negatively influence the seroconversion rates .  Vaccination against HBV during PEG plus RIB combination treatment is not beneficial in terms of anti-HBs seroconversion rates Background : Hepatitis B virus ( HBV ) vaccination is a well-known , safe and effective way for protection against HBV infection ; however , non-responders remain susceptible to infection with HBV . This is so important in patients with any kind of chronic liver disease , especially chronic hepatitis C virus ( HCV ) patients in whom acute HBV infection may lead to decompensation of liver disease . Some of the studies have shown that immunogenicity of HBV vaccination is decreased in these patients . The aim of this study was to evaluate the efficacy and safety of double dose vaccination of HBV in these patients , compared with st and ard dose vaccination in similar patients and healthy adults . Methods : A total of 64 patients with chronic HCV infection were r and omized into 2 groups of 32 . Group A received st and ard dose HBV vaccine , at 0 , 1 , 6 months , whereas group B received double dose HBV vaccine . Group C consisted of 32 healthy adults who also received st and ard dose vaccination . At 1 month after the end of vaccination , Hepatitis B surface antibody ( HBsAb ) titer was checked in all participants and the results were compared . Results : There was no significant difference in age or sex among three groups . The response rate in groups B and C was 100 % ( all had HBsAb titer > 10 mIU/mL ) , while in group A , 4 patients ( 12.5 % ) were non-responders ( HBsAb titer < 10 mIU/mL ) . The difference in response rate was statistically significant between Group A and the other two groups ( P < 0.05 ) . Conclusions : The efficacy of st and ard dose HBV vaccination in patients with chronic HCV infection was suboptimal . Using double dose vaccination in these patients was an effective way to increase the antibody response The aim of the study was to evaluate the safety , immunogenicity , and possible therapeutic effect of hepatitis B vaccine in patients with chronic hepatitis C. The subjects studied included three groups : group I , 26 patients with chronic hepatitis C who were susceptible to hepatitis B virus infection ; group II , 35 healthy subjects who were susceptible to both hepatitis B and hepatitis C virus infection ; and group III , 30 patients with chronic hepatitis C receiving no hepatitis B vaccination as controls . Three 20 microg/dose of recombinant hepatitis B vaccines were given to subjects of groups I and II in months 0 , 1 , and 6 . Blood sample s from the subjects were collected before and 1 month after each dose of vaccination for serological testing . The subjects of groups I and II had similar antibody to hepatitis B surface antigen ( anti-HBs ) response rates after the first ( 30.8 % vs. 17.1 % ) , second ( 61.5 % vs. 60.0 % ) , and third ( 88.5 % vs. 91.4 % ) doses of vaccination . Also , their geometric mean titers of anti-HBs did not differ much when vaccination completed in 7 months ( 360 vs. 581 mIU/ml ) . During vaccination period , patients with chronic hepatitis C demonstrated no significant change of serum cytokines and HCV RNA levels , but significantly lowered ALT levels after three doses of vaccination . Hepatitis B vaccination is safe and immunogenic in patients with chronic hepatitis C. It did not significantly affect their levels of HCV RNA , but tended to lower ALT levels OBJECTIVES : The efficacy of the st and ard hepatitis B virus ( HBV ) vaccination schedule in individuals with chronic hepatitis C is reported to be reduced . Our aim was to assess the response rate to high dose , short interval HBV vaccination in such individuals . METHODS : A total of 152 individuals with chronic hepatitis C were vaccinated with 40 μg of vaccine administered monthly for 3 months . Twenty-six individuals with no evidence of liver disease underwent the same vaccination schedule and were considered to be the control group . Hepatitis C virus (HCV)-positive subjects who did not seroconvert to anti-hepatitis B surface positivity after the third dose of the vaccine ( nonresponder ) were vaccinated with a fourth dose of vaccine ( booster dose , 80 μg ) . RESULTS : One hundred nine of the 152 individuals with chronic hepatitis C ( 72 % ) seroconverted to anti-hepatitis B surface positivity ( > 10 mIU/ml ) , as compared to 24 of the 26 controls ( 92 % , p < 0.05 ) . Although individuals with chronic hepatitis C responded less frequently to high dose , short interval HBV vaccination than did the controls , no differences in terms of effective immunity ( > 100 mIU/ml ) were evident among the two groups of responders ( 51 % vs 54 % ) . Also , no difference in response was reported between individuals with chronic active hepatitis C and controls ( 92 % vs 80 % ) . The response rate was significantly lower in cirrhotics than in the noncirrhotic group ( 54 % vs 80 % , p < 0.001 ) . Besides cirrhosis , no other demographic or bio clinical factor was found to influence the response to vaccination . After the additional booster dose , the overall response was increased to 74 % of the cirrhotics and 88 % of the noncirrhotics . No major HBV vaccine-related adverse effects were seen . CONCLUSIONS : A high dose , short interval HBV vaccination schedule is safe in individuals with chronic hepatitis C. From these data , it is suggested that a high dose and a short interval between HBV vaccinations may produce an effective and early antibody response in such patients OBJECTIVE To compare the antibody response between adults with hepatitis B virus ( HBV ) core antibody ( anti-HBc ) single positivity and healthy adults after primary immunization and revaccination of hepatitis B vaccine(HepB ) .  METHODS Adults aged from 18 to 49 who were both negative for HBV surface antigen ( HBsAg ) and antibody to HBsAg ( anti-HBs ) , but positive for anti-HBc and narrated no history of HepB immunization by themselves , were selected as single anti-HBc positive group ( ' anti-HBc alone ' ) . Adults who were negative for HBsAg , anti-HBs and anti-HBc , with age differences within 2 years , and same gender under the 1 : 1 matching program 
    Output:
    
Our meta- analysis showed patients with hepatitis C infection have a statistically significant lower rate of seroconversion in comparison to healthy controls , both in cirrhotic and non-cirrhotic patients .
Chronic HCV infection can decrease the immune response to a st and ard schedule of hepatitis B vaccination .