HAV infection in Brazilian men who have sex with men: The importance of surveillance to avoid outbreaks

Background Hepatitis A is a fecal-oral infection caused by hepatitis A virus (HAV). Men who have sex with men (MSM) and transgender women (TW) have been reported as target groups for HAV infection. This study aimed to determine the seroprevalence, risk factors, and circulating strains associated with HAV infection among MSM and TW in Central Brazil. Methods A cross-sectional study was conducted from November 2011 to September 2013. Serum samples were collected from 425 individuals for anti-HAV antibody testing and HAV molecular characterization. Of them, 149 (35.1%) participants were self-identified as transgender women. Statistical analysis was performed to evaluate the risk factors of HAV seropositivity. Results The seroprevalence of HAV exposure was 69.7% (95% Confidence Interval: 65.3-74.0%). Serological evidence of HAV was significantly higher in participants who self-identified as transgender women (83.2%) than MSM (62.3%). Increasing age, non-white race, and lower monthly household income were independently associated with HAV exposure among MSM. Only lower monthly household income was independently associated with HAV exposure among TW. One anti-HAV IgM positive sample, from a transgender woman (0.2%), was detected and classified as subgenotype IA. Conclusions High HAV prevalence was observed, markedly among TW. Considering the risky sexual behaviors this population is exposed to, HAV vaccination and prevention programs targeting this population should be considered to prevent outbreaks and the burden of the disease.