by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
September 22, 2020
Koibuchi T et al. Prevalence of Hepatitis A Immunity and Decision-tree analysis Among Men Who Have Sex With Men and are Living With Human Immunodeficiency Virus in Tokyo. Clin Infect Dis 2020;71(3):473-479. DOI:10.1093/cid/ciz843
Infection with Hepatitis A virus (HAV) remains problematic in many parts of the world including the U.S. where there have been outbreaks reported since 2016. HAV is transmitted via a fecal-oral route, usually from direct person-to-person contact or consumption of contaminated food or water. The CDC has recommended HAV vaccine for children since 2006 and subsequently for other at-risk persons. This study from Japan looked at seroprevalence of HAV-IgG antibody in 468 persons with HIV (PWH) in 2017. Also recorded was HAV vaccine status and previous HAV infection. After excluding females and persons previously vaccinated, data on 354 MSM were analyzed. Of this group of patients, approximately 20% were HAV-IgG positive and when they looked at those without a previous HAV vaccination only 17% were IgG positive. There was a positive correlation between patient age and HAV seropositivity. The lowest rate of IgG positivity (6%) was in patients younger than age 40. In men with a median age of 50 years or greater, there was also significantly higher rates of HBV, HCV, and Treponema pallidum consistent with sexual acquisition of HAV in these older persons. Although the overall prevalence of HAV IgG antibody was higher than in the general population, it was well below a rate of 70% which is the estimate needed to prevent sustained transmission of HAV.
I included this study from Japan as a reminder that we should be vaccinating our HIV patients for HAV consistent with the most recent CDC guidance  that now includes persons with HIV infection, MSM, IDU, persons who are homeless, persons with chronic liver disease, and international travelers. In the most recommendations, CDC notes that 87% of PWH are susceptible (have negative total or IgG anti-body results) to HAV infection due to lack of receipt of HepA vaccination, poor response to HepA vaccination, or no prior infection. Because the response to the vaccine might be reduced in PWH, post-vaccination serologic testing should be performed ≥1 month after completing the HepA series.
Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep 2020;69(No. RR-5):1–38.DOI: http://dx.doi.org/10.15585/mmwr.rr6905a1
The author has no conflicts of interest to disclose.
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