Abstract
We evaluated the association between urinary arsenic and the seroprevalence of total hepatitis A antibodies (total anti-HAV: IgG and IgM) in 11 092 participants aged ⩾6 years using information collected in the US National Health and Nutrition Examination Survey (2003-2012). Multivariate logistic regression models evaluated associations between total anti-HAV and total urinary arsenic defined as the sum of arsenite, arsenate, monomethylarsonate and dimethylarsinate (TUA1). Effect modification by self-reported HAV immunization status was evaluated. Total anti-HAV seroprevalence was 35·1% [95% confidence interval (CI) 33·3-36·9]. Seropositive status was associated with higher arsenic levels and this association was modified by immunization status (P = 0·03). For participants that received ⩾2 vaccine doses or did not know if they had received any doses, a positive dose-response association was observed between increasing TUA1 and odds of total anti-HAV [odds ratio (OR) 1·42, 95% CI 1·11-1·81; and OR 1·75, 95% CI 1·22-2·52], respectively. A positive but not statistically significant association was observed in those who received <2 doses (OR 1·46, 95% CI 0·83-2·59) or no dose (OR 1·12, 95% CI 0·98-1·30). Our analysis indicates that prevalent arsenic exposure was associated with positive total anti-HAV seroprevalence. Further studies are needed to determine if arsenic increases the risk for incident hepatitis A infection or HAV seroconversion.
Highlights
ObjectivesThe objective of this study was to investigate the cross-sectional association between arsenic exposure and immune response to Hepatitis A virus (HAV) in a representative sample of the US population
TUA was slightly higher for females, in individuals reporting to be multiracial or of other race followed by Mexican Americans, and in individuals living in households above the poverty level for total urinary arsenic 2 (TUA2) but not for Total urinary arsenic 1 (TUA1)
Given the cross-sectional nature of this study and reliance on total anti-Hepatitis A virus (HAV) as the outcome, we cannot ascertain whether arsenic exposure is related to increased risk of hepatitis A infection or if toxic exposure modulates the immunological response to vaccination since a positive total anti-HAV test is not able to distinguish between a present, previous infection, or vaccineinduced immunity [31]
Summary
The objective of this study was to investigate the cross-sectional association between arsenic exposure and immune response to HAV in a representative sample of the US population
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