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[Carriers of hepatitis C: should they all be vaccinated for hepatitis A?]
M Sans1, S Escorza, D Villagrasa
1Especialistas en Medicina de Familia y Comunitaria, El Prat de Llobregat, Unidad Docente de Medicina de Familia y Comunitaria Costa de Ponent, Barcelona, Spain.
Insights
Hepatitis C virus (HCV) patients under 40 show similar hepatitis A virus (HAV) immunity to the general population. Vaccination against HAV is recommended for all HCV-infected individuals, with age-specific considerations for those over 40 with chronic liver disease.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) infection is a significant global health concern.
- Coinfection with other viral hepatitis, such as hepatitis A virus (HAV), can complicate management and prognosis.
- Assessing HAV immunity in HCV-infected populations is crucial for targeted vaccination strategies.
Purpose of the Study:
- To determine the prevalence of hepatitis A virus (HAV) immunity among patients with hepatitis C virus (HCV) infection.
- To identify subgroups within the HCV-infected population who may benefit most from HAV vaccination.
Main Methods:
- A descriptive, cross-sectional study was conducted at an urban health center.
- The study included 134 patients aged over 14 years with confirmed HCV infection.
- Data collected included demographics, presence of chronic liver disease, and serological markers for hepatitis B, HAV, and HIV.
Main Results:
- Of 134 HCV-positive patients, 56% were tested for HAV, with 86.7% showing immunity.
- Younger patients (under 40) with HCV had HAV immunity levels comparable to the general population.
- HCV patients over 40 with chronic liver disease had a higher prevalence of HAV seronegativity.
Conclusions:
- Hepatitis A virus (HAV) vaccination should be considered for all individuals with hepatitis C virus (HCV) infection.
- For HCV patients under 40, HAV immunity is generally high, similar to the general population.
- For HCV patients over 40 with chronic liver disease, HAV vaccination decisions should be guided by serological testing.
Aim:
To investigate the prevalence of immunization against hepatitis A virus (HAV) in persons with hepatitis C virus (HCV) infection, in order to determine who should be vaccinated for the former.
Design:
Descriptive, cross-sectional study.
Setting:
Urban health center serving 12 000 inhabitants.
Participants:
Patients older than 14 years positive for HCV infection.
Variables:
presence of chronic liver disease, serological indications of hepatitis B, A, and immune deficiency virus (HIV) infection, vaccination for hepatitis B.
Results:
A total of 134 persons (70.9% men and 29.1% women) comprised the sample of patients positive for HCV infection. Mean age was 41.75 years (SD, 16.55 years). Nearly all patients (93.3%) had chronic liver disease, 56.7% were intravenous drug users, 56% were positive for Hbc antibodies and 32.8% were positive for HIV. Serological testing for HAV was done in 75 patients (56%); the result was positive in 86.7%. Mean age in this subgroup was 50.4 years (SD, 17.8 years). In the HAV-negative subgroup, mean age was 36.6 years (SD, 15 years; P=.02). Serological testing for HAV could not be done in 44% of the patients: 33.6% did not respond to attempts to contact them by telephone or in writing, 6% were temporarily away from home, and 1 patient declined to be tested. The response to requests to obtain blood samples was better in women (66.7%), HIV-negative patients (34.7%), persons who were not intravenous drug users (43.3%) and persons with chronic liver disease (60%).
Conclusions:
In persons younger than 40 years, the proportion of seronegative individuals is similar to that in the general population. Vaccination should be considered for all patients positive for HCV infection. In persons older than 40 years with chronic liver disease, the decision to vaccinate for HAV should be made in the light of serological findings.