Antibodies to hepatitis A virus in Italian patients with chronic liver disease

To improve our knowledge for future hepatitis A virus (HAV) vaccination str ategies we carried out a multicentre study on naturally acquired immunologi cal protection against HAV in patients with chronic hepatitis in Italy. We enrolled 830 consecutive patients with chronic hepatitis on their first obs ervation at one of the six Italian liver units participating in the study. Six hundred and fifty-eight patients (79.3%) were positive for total anti-H AV and 172 (20.7%) were negative. The anti-HAV negative patients were young er (median age 33, range 11-78) than the anti-HAV positive (median age 56, 18-87). There was a higher prevalence of cases with circulating anti-HAV am ong the 508 patients residing in southern Italy than in the 322 residing in northern Italy (88.8% vs. 64%, P < 0.001). No significant difference in th e anti-HAV prevalence was observed between patients from northern Italy and those from southern Italy aged 0-30 years or in those over 60 years, while in those 31-60 years old there was a higher prevalence of anti-HAV positiv e patients from southern Italy (90.2% vs. 65.8%, P < 0.0001). Of the patien ts with liver cirrhosis in this study, only 3 of the 26 (11.5%) from northe rn Italy and 8 of the 228 (3.5%) from southern Italy had no immunological p rotection against HAV infection. The data suggest that the number of patien ts with chronic liver disease without naturally acquired immunity against H AV is substantial in Italy, particularly in the north of the country, and t hat new vaccination strategies are needed.