Hepatitis A seroprevalence in patients with chronic hepatitis B and C at the initiation of treatment

Year 2026, Volume: 19 Issue: 2 , 385 - 389 , 13.04.2026

Şerife Altun Demircan , Sami Kınıklı , Esra Kaya Kılıç , Cigdem Ataman Hatipoglu

https://doi.org/10.31362/patd.1753390

https://izlik.org/JA86DA37NB

Abstract

Purpose: Hepatitis A is a vaccine-preventable disease that may follow a more severe course and can lead to fulminant hepatitis in patients with chronic hepatitis. The aim of this study is to determine the seroprevalence of hepatitis A in patients with chronic hepatitis B and C, and to assess the need for hepatitis A vaccination.
Materials and methods: A total of 885 adult patients with chronic hepatitis B and C, who had not previously received hepatitis A vaccination and in whom antiviral therapy was initiated between January 2008 and December 2020, were included in the study. Immunity against hepatitis A was assessed at the time of diagnosis by measuring Anti-HAV IgG using the Microparticle Enzyme Immunoassay (MEIA; AxSYM-HAVAB 2.0, ABBOTT) method.
Results: The seroprevalence of hepatitis A was 92.7% among 789 patients with chronic hepatitis B and 96 patients with chronic hepatitis C; it was determined to be 94% in patients with chronic hepatitis B and 83% in patients with chronic hepatitis C. While 78% of anti-HAV IgG seronegativity was detected in individuals under 30 years of age, 90% of seronegative cases were under 40. Seropositivity approached 100% in those over 50 years of age; however, a 64-year-old man and a 68-year-old woman with chronic hepatitis C were not immune to hepatitis A.
Conclusion: Since hepatitis A superinfection in patients with chronic hepatitis B and C may follow a severe course and lead to a fulminant course, it should be kept in mind that hepatitis A seroprevalence is low, particularly in patients under 30 years of age. However, although the rate decreases with age in adult patients, seronegativity may be detected at any age; therefore, Anti-HAV IgG should be evaluated at the time of diagnosis in all patients with chronic hepatitis, and those found to be negative should be vaccinated against hepatitis A.

Keywords

Chronic hepatitis B , chronic hepatitis C , hepatitis A seroprevalence , vaccination

Tedavi başlanan kronik hepatit B ve C hastalarında hepatit A seroprevalansı

https://izlik.org/JA86DA37NB

Abstract

Amaç: Hepatit A kronik hepatit hastalarında daha ağır seyredip fulminan hepatite neden olabilen aşı ile önlenebilir bir hastalıktır. Çalışmanın amacı kronik hepatit B ve C hastalarında hepatit A seroprevalansını saptamak ve hepatit A aşı gereksinimini belirlemektir.
Gereç ve yöntem: Çalışmaya Ocak 2008 ve Aralık 2020 yılları arasında antiviral tedavi başlanan daha önce hepatit A aşısı yapılmamış erişkin 885 kronik hepatit B ve C hastası dahil edildi. Hepatit A’ya karşı bağışıklık Anti-HAV IgG (Microparticle Enzyme Immunoassay (MEIA; AxSYM-HAVAB 2.0, ABBOTT) yöntemi ile tanı anında değerlendirildi.
Bulgular: Kronik hepatit B olan 789 ve kronik hepatit C olan 96 hastada hepatit A seroprevalansı %92,7 olup kronik hepatit B hastalarında %94, kronik hepatit C hastalarında %83 olarak saptandı. Anti-HAV IgG seronegatifliğinin %78’i 30 yaş altında saptanırken, seronegatiflerin %90’ı 40 yaş altında idi. 50 yaş üstünde seropozitiflik %100’e yakın olup 64 yaş erkek ve 68 yaş kadın iki kronik hepatit C hastası hepatit A’ya karşı bağışık değildi.
Sonuç: Kronik hepatit B ve C hastalarında hepatit A süperenfeksiyonu ciddi seyredip fulminan seyir gösterebileceğinden özellikle 30 yaş altı hastalarda hepatit A seroprevalansının düşük olduğu unutulmamalıdır. Ancak erişkin hastalarda oran yaşla birlikte azalsa da her yaşta seronegatiflik saptanabileceğinden tanı aldığı anda tüm kronik hepatit hastalarında Anti-HAV IgG değerlendirilmeli ve negatif saptananlara hepatit A aşısı yapılmalıdır.

Keywords

Kronik hepatit B , kronik hepatit C , hepatit A seroprevalansı , aşılama

References

• Averhoff F, Khudyakov Y, Bell BP. Hepatitis A virus. In: Bennett JE, Dolin R, Blaser MJ (eds) Mandell, Douglas, And Bennett’s Principles And Practise OfInfectious Diseases, 9th edition, Philadelphia: 2020 Elsevier; 2243-2261. Available at: https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323482554001740. Accessed 15.06.2025
• WHO, Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Available at: https://www.who.int/publications/i/item/9789241549059. Accessed 17.06.2025
• World Health Organization. (‎2010)‎. The global prevalence of hepatitis A virus infection and susceptibility : a systematic review. World Health Organization. Available at: https://iris.who.int/handle/10665/70180. Accessed 18.06.2025
• Global Hepatitis Report 2017. Geneva: World Health Organization; 2017. Available at: https://www.who.int/publications/i/item/9789241565455. Accessed 18.06.2025
• Keeffe EB. Is hepatitis A more severe in patients with chronic hepatitis B and other chronic liver diseases? Am J Gastroenterol. 1995;90(2):201-205.
• Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Comittee on Immunization Practices, 2020. MMWR Recomm Rep. 2020;69(no.RR):1-38. doi:10.15585/mmwr.rr6905a1
• Arguedas MR, Johnson A, Eloubeidi MA, Fallon MB. Immunogenicity of Hepatitis A Vaccination in Decompensated Cirrhotic Patients. Hepatology. 2001;34(1):28-31. doi:10.1053/jhep.2001.25883
• Reiss G, Keeffe EB. Hepatitis vaccination in patients with chronic liver disease. Aliment Pharmacol Ther. 2004;19(7):715-727. doi:10.1111/j.1365-2036.2004.01906.x
• Keeffe EB, Iwarson S, McMahon BJ, et al. Safety and immunogenicity of hepatitis A vaccine in patients with chronic liver disease. Hepatology. 1998;27(3):881-886. doi:10.1002/hep.510270336
• Hepatit A Enfeksiyonlarından Korunma. Türkiye Viral Hepatit Kontrol ve Önleme Programı 2018-2023. Ankara 2018: 4. Available at: https://hsgm.saglik.gov.tr/depo/Yayinlarimiz/Programlar/Turkiye_Viral_Hepatit_Onleme_ve_Kontrol_Programi_2018-2023.pdf. Accessed 24.06.2025
• Hepatit B Enfeksiyonlarından Korunma “Aşılama”. Türkiye Viral Hepatit Kontrol ve Önleme Programı 2018-2023. Ankara. Available at: https://hsgm.saglik.gov.tr/depo/Yayinlarimiz/Programlar/Turkiye_Viral_Hepatit_Onleme_ve_Kontrol_Programi_2018-2023.pdf. Accessed 24.06.2025
• Halicioglu O, Akman SA, Tatar B, Atesli R, Kose S. Hepatitis A seroprevalence in children and adolescents aged 1 to 18 years among a low socioeconomic population in Izmir, Türkiye. Travel Med Infect Dis. 2012;10(1):43-47. doi:10.1016/j.tmaid.2012.01.001
• Demiray T, Köroğlu M, Jacobsen KH, Özbek A, Terzi HA. Altındiş M. Hepatitis A virus epidemiology in Türkiye as universal childhood vaccination begins: seroprevalence and endemicity by region. Turk J Pediatr. 2016;58(5):480-491. doi:10.24953/turkjped.2016.05.004
• Çelen MK, Turker K, Oztoprak N, et al. The evaluation of exposure to hepatitis A virus in HBsAg-positive persons: A multicentre study from Turkey. Journal of Pure and Applied Microbiology. 2014;8(4):3063-3068.
• Ceyhan M, Yildirim I, Kurt N, et al. Differences in hepatitis A seroprevalence among geographical regions in Türkiye: A need for regional vaccination recommendations. J Viral Hepat. 2008;15(2):69-72. doi:10.1111/j.1365-2893.2008.01034.x
• Özden HT. Hepatitis A seroprevalence in patients with chronic viral hepatitis in Konya, Türkiye. Eur J Gastroenterol Hepatol. 2016;28(3):333-337. doi:10.1097/MEG.0000000000000547
• Ataman Hatipoğlu Ç, Kınıklı S, Tekin Koruk S, et al. İnaktif Hepatit B Taşıyıcıları ile Kronik Hepatit B, C ve D Olgularında Anti-HAV Total Prevalansı. Viral Hepatit Dergisi 2005;10(3):164-168.
• Alpay Y. Evaluation of seroprevalence of hepatitis A virus infection among patients with chronic hepatitis B virus infection. Klimik Derg. 2019;32(1):19-21. doi:10.5152/kd.2019.06
• Bekçibaşı M. Hepatitis A seroprevalence in chronic hepatitis B patients in Diyarbakir, Türkiye. Klimik Derg. 2020;33(1):36-38. doi:10.5152/kd.2020.07