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[Viral hepatitis A with prolonged course in adults]
C Altman1, C Molinié, S Soudière
1Service des Maladies du Foie et de l'Appareil Digestif, Hôpital Bicêtre, Le Kremlin Bicêtre.
Objective:
The aim of this study was to determine the clinical and virological characteristics of patients with type A viral hepatitis and a protracted course.
Methods:
Twenty-seven patients with hepatitis A virus and elevated serum ALT levels for more than 6 months were studied. Patients were tested for hepatitis C and E virus using conserved serums.
Results:
A biological relapse was defined by a decrease of the serum ALT levels > or = 50% followed by a > or = 50% increase in the minimal value. Biological relapses occurred in all patients. The median time between the onset of the disease and the first relapse was 87 days. During relapse, jaundice and ascites were present in five and one patients, respectively. All patients recovered. Serum aminotransferase activities returned to the normal range in a median of 230 days. None of the 17 tested patients had hepatitis C virus antibodies. Sixteen patients were tested for hepatitis E virus antibodies; 8 were positive for IgG and one for IgM. Sixteen control patients with acute hepatitis A of short duration, matched for date and country of contamination, were also tested for antibodies to hepatitis E virus; 11 were positive for IgG and none for IgM.
Conclusion:
A protracted course of type A viral hepatitis is characterised by relapses with or without symptoms. The high frequency of a positive test for hepatitis E IgG associated with a negative test for IgM in patients with and without a protracted course does not suggest that hepatitis E virus plays a role in patients with a protracted course. These positive results might be due to either false positive results or to past contamination.