Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2017; 23(20): 3589-3606
Published online May 28, 2017. doi: 10.3748/wjg.v23.i20.3589
Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review
Kuan-Yin Lin, Guan-Jhou Chen, Yu-Lin Lee, Yi-Chia Huang, Aristine Cheng, Hsin-Yun Sun, Sui-Yuan Chang, Chun-Eng Liu, Chien-Ching Hung
Kuan-Yin Lin, Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei 20844, Taiwan
Guan-Jhou Chen, Yi-Chia Huang, Aristine Cheng, Hsin-Yun Sun, Chien-Ching Hung, Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan
Aristine Cheng, Hsin-Yun Sun, Chien-Ching Hung, National Taiwan University College of Medicine, Taipei 10002, Taiwan
Yu-Lin Lee, Chun-Eng Liu, Department of Internal Medicine, Changhua Christian Hospital, Changhua 50006, Taiwan
Sui-Yuan Chang, Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei 10048, Taiwan
Sui-Yuan Chang, Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
Chien-Ching Hung, Department of Parasitology, National Taiwan University College of Medicine, Taipei 10048, Taiwan
Chien-Ching Hung, Department of Medical Research, China Medical University Hospital, Taichung 40402, Taiwan
Chien-Ching Hung, China Medical University, Taichung 40402, Taiwan
Author contributions: Lin KY, Chen GJ, Lee YL, Huang YC, Cheng A, Sun HY and Chang SY performed the literature search and review, and wrote the paper; Liu CE and Hung CC edited and revised the manuscript.
Supported by Centers for Disease Control, Taiwan, No. JH105022.
Conflict-of-interest statement: Chien-Ching Hung has received research support from Janssen, Abbvie, Bristol-Myers Squibb, Merck, and ViiV and speaker honoraria from Gilead Sciences, and served on the advisory boards for Gilead Sciences, ViiV, Abbvie, and Janssen. Other authors report no potential conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chien-Ching Hung, MD, PhD, Clinical Professor, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan. hcc0401@ntu.edu.tw
Telephone: +886-2-23123456-67552 Fax: +886-2-23707772
Received: February 12, 2017
Peer-review started: February 14, 2017
First decision: March 16, 2017
Revised: March 31, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: May 28, 2017
Abstract

Hepatitis A virus (HAV) is one of the most common infectious etiologies of acute hepatitis worldwide. The virus is known to be transmitted fecal-orally, resulting in symptoms ranging from asymptomatic infection to fulminant hepatitis. HAV can also be transmitted through oral-anal sex. Residents from regions of low endemicity for HAV infection often remain susceptible in their adulthood. Therefore, clustered HAV infections or outbreaks of acute hepatitis A among men who have sex with men and injecting drug users have been reported in countries of low endemicity for HAV infection. The duration of HAV viremia and stool shedding of HAV may be longer in human immunodeficiency virus (HIV)-positive individuals compared to HIV-negative individuals with acute hepatitis A. Current guidelines recommend HAV vaccination for individuals with increased risks of exposure to HAV (such as from injecting drug use, oral-anal sex, travel to or residence in endemic areas, frequent clotting factor or blood transfusions) or with increased risks of fulminant disease (such as those with chronic hepatitis). The seroconversion rates following the recommended standard adult dosing schedule (2 doses of HAVRIX 1440 U or VAQTA 50 U administered 6-12 mo apart) are lower among HIV-positive individuals compared to HIV-negative individuals. While the response rates may be augmented by adding a booster dose at week 4 sandwiched between the first dose and the 6-mo dose, the need of booster vaccination remain less clear among HIV-positive individuals who have lost anti-HAV antibodies.

Keywords: Epidemiology, Viral hepatitis, Acute hepatitis, Fecal-oral transmission, Oral-anal sex, Men who have sex with men, Injecting drug use, Immunosuppression, Immunization

Core tip: We provide an updated review of hepatitis A virus (HAV) coinfection among human immunodeficiency virus (HIV)-positive individuals, focusing on the epidemiology, clinical manifestations, and prevention for HAV infection. The reported outbreaks of acute hepatitis A among men who have sex with men and injecting drug users are summarized. Updated vaccination guidelines for prevention of HIV-positive individuals against HAV infection are presented. We also review the published data of effectiveness or efficacy of HAV vaccination studies and the different approaches to improvement of the serological responses to conventional HAV vaccines among HIV-positive individuals.