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

Öz

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.

Anahtar Kelimeler

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

Tedavi başlanan kronik hepatit B ve C hastalarında hepatit A seroprevalansı

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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