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Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C
1Department of Infectious Diseases, University of Verona, Verona, Italy. vento@borgotrento.univr.it
Insights
Acute Hepatitis A Virus (HAV) infection in patients with chronic Hepatitis C Virus (HCV) can lead to severe outcomes. Certain HLA phenotypes may increase the risk of fulminant hepatitis in coinfected individuals.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Conflicting reports exist regarding the clinical outcomes of acute Hepatitis A Virus (HAV) infection in patients with chronic Hepatitis C Virus (HCV) infection.
- Chronic liver disease (CLD) is a known risk factor for increased mortality following HAV infection.
Purpose of the Study:
- To prospectively evaluate the clinical outcome of acute HAV infection in patients with chronic HCV.
- To identify factors associated with severe outcomes, including fulminant hepatitis and mortality, in coinfected patients.
Main Methods:
- A prospective study followed 432 patients with chronic HCV over 7 years.
- Clinical outcomes, including development of fulminant hepatitis and mortality, were recorded for patients with concurrent HAV infection.
Main Results:
- Of 17 patients with concurrent HAV/HCV infection, seven developed fulminant hepatitis and six died.
- Fulminant hepatitis occurred in patients without cirrhosis, but the HLA phenotype (A1; B8:DR3) was a significant risk factor.
- Patients with this phenotype exhibited high autoantibody titers, suggesting possible autoimmune hepatitis induction.
Conclusions:
- Acute HAV infection poses a significant risk of fulminant hepatitis and mortality in patients with chronic HCV, particularly those with specific HLA phenotypes.
- The presence of chronic liver disease appears to be an important underlying factor.
- Further prospective studies are necessary to fully elucidate the mechanisms and risk factors involved in HAV/HCV coinfection outcomes.
Abstract:
There have been conflicting reports of the clinical outcome of acute hepatitis A virus (HAV) infection in patients with chronic hepatitis C virus (HCV) infection. A prospective study evaluated 432 patients with chronic hepatitis C (183 with cirrhosis) over a 7-year period. Of the 17 patients with concurrent HAV infection, seven developed fulminant hepatitis and six died. None of these patients had cirrhosis; however, the HLA phenotype (A1; B8:DR3) appeared to be a significant factor in the development of fulminant hepatitis. Patients with this phenotype had high titres of antinuclear antibodies, antismooth muscle antibodies and antiasialoglycoprotein-receptor antibodies, possibly reflecting the induction of autoimmune hepatitis in this group. The high frequency of fulminant hepatitis in patients with HAV/HCV coinfection contrasts with other surveys, although a large Centers for Disease Control and Prevention (CDC) survey demonstrated that HAV infection in patients with pre-existing chronic liver disease (CLD) is associated with increased mortality. It is likely that CLD has some importance as an underlying factor in the development of fulminant hepatitis following HAV infection. Further prospective studies are needed to clarify this issue.