Siddiqui F, Mutchnick M, Kinzie J, Peleman R, Naylor P, Ehrinpreis M
Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
Am J Gastroenterol. 2001 Mar;96(3):858-63. doi: 10.1111/j.1572-0241.2001.03633.x.
Administration of vaccine for hepatitis A virus (HAV) and hepatitis B virus (HBV) is recommended for patients with chronic hepatitis C (CHC) because of the potential for increased severity of acute hepatitis superimposed on existing liver disease. The aim of this study is to determine the prevalence of antibodies directed against HAV and HBV in patients with CHC, analyze demographic and risk factors associated with this prevalence, and develop a cost-effective vaccination strategy.
We reviewed records from 1092 CHC patients. Demographics and information regarding risk factors were obtained by history and questionnaire administered to all patients. The costs of vaccination and antibody testing were determined, based on standard laboratory and clinic charges at our institution. HAV and HBV markers were correlated to race, age, and risk factors.
Of the total population studied (n = 1092), 72% were African-Americans, 27% white, and 1% others. Of 671 CHC patients tested for anti-HAV IgG, 252 (38%) were positive. Of 743 CHC patients tested for HBV antibodies (anti-hepatitis B core IgG or anti-hepatitis B surface), 494 (67%) were positive. African-Americans are more likely to have antibodies to HAV and HBV (67% and 75%, respectively) compared to whites (27% and 20%). The prevalence of anti-HAV was 76% in patients >60 yr, 34% in the 40- to 60-yr-old age group, and 21% in patients <40 yr. The highest prevalence of HBV antibodies was found in patients between the ages of 40-60 yr. No HCV risk factors were associated with increased HAV risk. In CHC patients with HBV antibodies, however, illicit injection drug use was the predominant risk factor.
The prevalence of anti-HAV in patients with CHC was found to be similar to that of the general population in the United States (33% according to recent Centers for Disease Control data), consistent with the hypothesis that the two infections do not share risk factors. Because the prevalence of HAV immunity is low in CHC patients <40 yr, empiric HAV vaccination is cost effective. If two doses of vaccine are to be given, however, antibody testing of all HCV patients is indicated. In the subset of patients >60 yr of age or who are African-American, where the prevalence of HAV exposure is considerably higher, it would be cost effective to check the antibody ($36.00), before vaccination ($97.00). The prevalence of HBV antibodies, however, is significantly increased in patients with CHC compared with the general population (5.3% per the Centers for Disease Control), likely as a result of exposure to similar parenteral risk factors. HBV antibody testing ($26.00 per test) should, therefore, be undertaken in all CHC patients who are hepatitis B surface antigen negative, as this approach is cost-effective compared to empiric HBV vaccination ($438.00 for a three injection course).
对于慢性丙型肝炎（CHC）患者，推荐接种甲型肝炎病毒（HAV）和乙型肝炎病毒（HBV）疫苗，因为叠加于现有肝病之上的急性肝炎病情可能加重。本研究的目的是确定CHC患者中抗HAV和抗HBV抗体的流行率，分析与该流行率相关的人口统计学和风险因素，并制定具有成本效益的疫苗接种策略。
我们回顾了1092例CHC患者的记录。通过对所有患者进行病史询问和问卷调查来获取人口统计学信息和风险因素信息。根据我们机构的标准实验室和临床收费标准确定疫苗接种和抗体检测的费用。将HAV和HBV标志物与种族、年龄和风险因素进行关联分析。
在总共研究的人群（n = 1092）中，72%为非裔美国人，27%为白人，1%为其他种族。在671例接受抗HAV IgG检测的CHC患者中，252例（38%）呈阳性。在743例接受HBV抗体（抗乙肝核心IgG或抗乙肝表面抗体）检测的CHC患者中，494例（67%）呈阳性。与白人（分别为27%和20%）相比，非裔美国人更有可能拥有抗HAV和抗HBV抗体（分别为67%和75%）。60岁以上患者中抗HAV的流行率为76%，40至60岁年龄组为34%，40岁以下患者为21%。HBV抗体的最高流行率出现在40至60岁的患者中。没有丙型肝炎病毒风险因素与HAV风险增加相关。然而，在有HBV抗体的CHC患者中，非法注射毒品使用是主要风险因素。
发现CHC患者中抗HAV的流行率与美国普通人群相似（根据疾病控制中心最近的数据为33%），这与两种感染不存在共同风险因素的假设一致。由于40岁以下CHC患者中HAV免疫力的流行率较低，经验性接种HAV疫苗具有成本效益。然而，如果要接种两剂疫苗，则需要对所有丙型肝炎病毒患者进行抗体检测。在60岁以上或非裔美国人的患者亚组中，HAV暴露的流行率相当高，在接种疫苗（97美元）前检测抗体（36美元）具有成本效益。然而，与普通人群相比，CHC患者中HBV抗体的流行率显著增加（疾病控制中心数据为5.3%），这可能是由于接触类似的非肠道风险因素所致。因此，对于所有乙肝表面抗原阴性的CHC患者都应进行HBV抗体检测（每次检测26美元），因为与经验性接种HBV疫苗（一个三针疗程438美元）相比，这种方法具有成本效益。
