Fazlina, Ahmad
(2010)
Anti-hepatitis a virus seroprev alence
among chronic viral hepatitis band c
liver disease in husm and its association
with cyp3a4*18 polymorphism.
Masters thesis, Universiti Sains Malaysia.
Abstract
Vaccination against hepatitis A virus is recommended in patients with chronic liver disease to
prevent hepatic decompensation due to superinfection. CYP3A4 is the major cytochrome in
humans and its activity is reduced in chronic liver disease as well as hepatic cirrhosis.
Detection of CYP3A4 polymorphism may predict detrimental effects on patients with chronic
viral hepatitis with superimposed Hepatitis A infection due to reduced hepatic activity to
eliminate drugs and harmful environmental toxin. Therefore, the need for vaccination is
augmented. The aim of this study is to find out the seroprevalence of anti-HAY antibodies in
patients with chronic viral hepatitis B and C liver disease and its association with CYP3A4
polymorphism as well as to justify the need for vaccination against hepatitis A in these
patients. From July to September 2009, 120 patients attending the Gastroenterology Clinic, Hospital
Universiti Sains Malaysia were enrolled into this case control study. The diagnosis of chronic
viral hepatitis B and C liver disease was based on presence of viral markers of more than 6
months and the diagnosis of liver cirrhosis was based on clinical, biochemical, radiological profiles. Serum from all patients were tested for anti-HA VlgG using a commercially
available kit and blood was sent for CYP3A4 polymorphism analysis. The overall anti-HA V seroprevalence was 88.2%. The aetiology of chronic viral liver disease
was hepatitis B in 96 patients (80.7%) and hepatitis C in 23 patients (19.3%). The mean age
was 44.4 ±14. Patients were categorized by decades of age as follows: 24 (20.2%) patients in
the 21-30 age group, 22(18.5%) in the 31-40 age group, 31 (26.1 %) in the 41-50 age group,
23 (19.3%) in the 51-60 age group and 19 ( 16.0%) patients aged more than 60 years. The
seroprevalence according to age group was 66. 7%, 95.5%, 93.5%, 91.3% and 94.7%
respectively. There was marked increase of prevalence in age group after 30 years (p=0.008).
Seventeen patients were cirrhotics and the anti-HA V seroprevalence was I 00% compared to
non-cirrhotic group which was only 86.3%(p=0.216). CYP 3A4* 18 polymorphism was
detected in 3 of our chronic viral liver disease patients, with the frequency of 2.5% . All
patients with the CYP3A4*18 mutations were found to be heterozygous. Our study demonstrated that the overall seroprevalence was 88.2% and age was the most
important factor in determining anti-HA V positivity. Most patient aged more than 30 are
likely to have natural immunity towards hepatitis A. There was no significant association
between CP3A4* 18 mutation and anti-HA V serology. Since the prevalence of anti-HA VlgG
is high, the hepatitis A vaccination may not be routinely required in this region especially in
individual who are older than 30 years of age.
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