Arsenic exposure and the seroprevalence of total hepatitis A antibodies in the US population: NHANES, 2003-2012.

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.