Role of hepatitis A virus in diabetes mellitus

BACKGROUND: Although much information is available regarding hepatitis C virus infection and diabetes, less is known about the relationship between hepatitis A virus (HAV) infection and diabetes. AIM: To examine the roles of HAV in diabetes risk. METHODS: This cross-sectional study population included data from the National Health and Nutrition Examination Survey collected between 2005-2012. Adult subjects (≥ 20 years old) with available body mass index measurements, defined diabetes status, history of HAV vaccination, and HAV serology were included. HAV vaccination was based on self-reported history. Successful HAV immunization was defined as the presence of both vaccination and anti-HAV antibody. HAV infection was defined by the absence of vaccination but presence of anti-hepatitis A antibody. The odds ratio (OR) for diabetes with 95% confidence intervals (95%CI) was calculated for each HAV status and then adjusted for covariates. Sensitivity tests, based on different definitions of diabetes, were performed to verify the results. RESULTS: Among 19942 subjects, 4229 subjects (21.21%) received HAV vaccination and HAV antibody was present in 9224 subjects (46.25%). Although HAV infection was associated with an increased risk of diabetes (OR: 1.13; 95%CI: 1.08-1.18), HAV vaccination was not associated with diabetes (OR: 1.06; 95%CI: 0.95-1.18), and successful HAV immunization had no impact on the risk of diabetes (OR: 1.11; 95%CI: 0.97-1.27). Thus, HAV infection was an unlikely cause of diabetes. Alternatively, in non-vaccinated subjects, diabetes increased the risk of HAV infection by 40% (OR: 1.40, 95%CI: 1.27-1.54). CONCLUSION: An association between HAV infection and diabetes is observed which is best explained by an increased risk of HAV infection in diabetic patients. Diabetic subjects are more susceptible to HAV. Thus, HAV vaccination is highly recommended in diabetic patients.