S1388 High Prevalence of Hepatitis B Virus Susceptibility Among Patients With Non-Alcoholic Fatty Liver Disease (NAFLD)

Abstract

Introduction: As per Advisory Committee on Immunization Practices (ACIP) guidelines hepatitis B vaccination is recommended in all patients with chronic liver disease (CLD) including Non-Alcoholic Fatty Liver Disease (NAFLD). Superimposed hepatitis B infection in those with CLD can have severe disease. Despite availability of effective vaccine, hepatitis B vaccination coverage is 30% among adults in the US. We aim to look at the prevalence of hepatitis B susceptibility among patients with NAFLD. Methods: We performed a systematic review of online charts for patients who were referred to our liver research center from January 2019 to October 2021. Patients with NAFLD were identified and their demographics, medical history, HBV serologies and hemoglobin A1c were recorded. Other causes of fatty liver were excluded using detailed medical history and serological testing. For analysis, HBV susceptibility refers to non-reactive HBsAg, anti-HBc, and anti-HBs; immune due to prior vaccination is non-reactive HBsAg, anti-HBc and reactive anti-HBs. Results: A total of 166 patient charts were reviewed. 62.6 % (104) were female, 100% were Hispanic. Age ranged from 24 to 74 years (Median 54 years). 68% have hypertension, 72.8% have hyperlipidemia, 66.8% have type 2 DM with HbA1c ranging from 5.5 to 13.5 (Median 9.5), 33.2 % were non-diabetic with HbA1c ranging from 4.8 to 6.5. None tested positive for HBsAg or Anti-HCV. Overall, 83.7% were susceptible to Hepatitis B, 16.3% were immune due to vaccination, none with prior exposure to hepatitis B. There was no significant difference in prevalence of HBV susceptibility among patients with diabetes 85.6 % compared to patients without diabetes 80%. Immune status did not vary with age as younger patients (24-55 years) have similar immune status compared to older patients: 19% and 12% respectively. Conclusion: In this study 83.7 % of patients with NAFLD were susceptible to HBV infection. Among those, the majority (66.8%) of them also have another coexisting comorbidity, I.e., diabetes which puts them at risk of getting severe hepatitis B infection. We found that even patients without diabetes have higher prevalence of hepatitis B susceptibility (80%) which suggests lack of immunization coverage playing a role rather than suboptimal response alone. This study shows there is a gap in immunization coverage among NAFLD patients and a need for HBV vaccination awareness strategy in the community. It is also important to explore factors like genetics and cultural differences.Figure 1.: Prevalence of HBV susceptibility among patients with NAFLD