HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks

Abstract

Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3–74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.

Increase in Hepatitis A Cases Linked to Imported Strains to Rio de Janeiro, Brazil: A Cross-Sectional Study

“…The predominance of male gender (78.85%) has similarly been reported in other studies [11,13,35,36] and the Brazilian Ministry of Health Viral Hepatitis Bulletin [17,18]. Studies have reported sexual practices as significant risk factors for HAV infection, with the practices of oral, oroanal, and anal sex as important transmission routes [32][33][34][35]37]. Likewise, recent Brazilian studies suggested that the increased HAV incidence in Brazil could be associated with sexual practices between men [10,38].…”

Viral Hepatitis A, B and C in a Group of Transgender Women in Central Brazil

“…Unfortunately, data on HAV among TGW in Brazil are scarce. Recently, in another city in Central Brazil, Castro et al [ 20 ] reported an overall anti-HAV prevalence of 69.7%, ranging from 62.3% among MSM ( n = 276) to 83.2% among TGW ( n = 149). Among MSM aged ≤20 years, 60% were HAV-susceptible.…”

“…Among MSM aged ≤20 years, 60% were HAV-susceptible. In addition, Castro et al [ 20 ] observed one TGW who was anti-HAV-IgM-positive and, thus, a potential HAV disseminator in her network. She was aged 21 years, reported sex work, alcohol, and drug use, and did not use a condom during oral sex.…”

Factors associated with hepatitis A susceptibility among men who have sex with men using HIV pre-exposure prophylaxis in Northeastern Brazil: A cross-sectional study

“…The recruitment of participants was undertaken between September 30, 2021 and June,19 2023 by convenience sampling as participants attended scheduled PrEP visits at IMT-RN. The sample size was calculated using the website OpenEpi ( https://www.openepi.com/SampleSize/SSPropor.htm ), based on the prevalence of 62.3% for total anti-HAV antibodies among MSM [ 19 ], confidence limits of ± 6%, 5% of α-error and 20% of β-error. The study should include at least 251 individuals.…”

“…MSM are not included in the Brazilian immunization program. The HAV seroprevalence among MSM varies from 37.0% in Amsterdam to 62.3% in Central Brazil [ 18 , 19 ]. However, population immunity levels > 70% are needed to prevent outbreaks among MSM [ 20 ].…”