Seroepidemiology of hepatitis A in patients with chronic liver disease

Summary.  Hepatitis A virus (HAV) rarely causes fulminant hepatic failure in the general population. Yet it is a cause of significant morbidity and mortality in patients with chronic liver disease (CLD), in whom routine HAV vaccination is recommended. However, studies of HAV seroprevalence and exposure predictors in populations with CLD are scarce. We have studied a cohort of 473 patients with various causes of CLD between July 2000 and June 2002. Patients were stratified on the basis of age, gender, ethnicity and aetiology of liver disease. The HAV seroprevalence in patients with CLD was compared with that in the general population. We used a logistic regression analysis to identify independent predictors of HAV exposure. Of the 473 patients studied, HAV seroprevalence was available for 454 individuals. HCV, HBV, alcohol, and HCV and alcohol were the causes of CLD in 337, 72, 37 and eight patients, respectively. The overall HAV seroprevalence was 55% in the studied cohort. The age‐stratified HAV prevalence for ages 21–30, 31–40, 41–50, 51–60, 61–70 and greater than 70 years was 44, 51, 44, 63, 65 and 64%, respectively. Hispanic ethnicity, Asian ethnicity, alcohol use and ages of 51–70 years were found to be independent predictive variables of prior exposure to HAV. HAV infection in patients with CLD causes considerable morbidity and mortality. We demonstrated that age‐stratified seroprevalence of HAV in patients with CLD of various aetiologies is significantly higher than that of the general population, and identified several independent predictors of HAV prior exposure.

摘要。甲型肝炎病毒（HAV）在普通人群中很少引起暴发性肝衰竭。然而，它是慢性肝病（CLD）患者发病和死亡的重要原因，因此建议对慢性肝病患者进行常规甲型肝炎疫苗接种。但是，关于慢性肝病患者中甲型肝炎病毒血清阳性率和暴露预测因素的研究很少。我们研究了2000年7月至2002年6月期间473例因各种原因患有慢性肝病的患者队列。根据年龄、性别、种族和肝病病因对患者进行分层。将慢性肝病患者的甲型肝炎病毒血清阳性率与普通人群进行比较。我们使用逻辑回归分析来确定甲型肝炎病毒暴露的独立预测因素。在研究的473例患者中，454例患者有甲型肝炎病毒血清阳性率数据。丙型肝炎病毒（HCV）、乙型肝炎病毒（HBV）、酒精以及丙型肝炎病毒和酒精分别是337例、72例、37例和8例患者慢性肝病的病因。研究队列中的总体甲型肝炎病毒血清阳性率为55%。年龄在21 - 30岁、31 - 40岁、41 - 50岁、51 - 60岁、61 - 70岁和大于70岁的年龄分层甲型肝炎病毒患病率分别为44%、51%、44%、63%、65%和64%。西班牙裔、亚裔、饮酒以及年龄在51 - 70岁被发现是既往甲型肝炎病毒暴露的独立预测变量。慢性肝病患者中的甲型肝炎病毒感染导致相当高的发病率和死亡率。我们证明了不同病因的慢性肝病患者中年龄分层的甲型肝炎病毒血清阳性率显著高于普通人群，并确定了几个甲型肝炎病毒既往暴露的独立预测因素。