Less Severe but Prolonged Course of Acute Hepatitis A in Human Immunodeficiency Virus (HIV)–Infected Patients Compared With HIV-Uninfected Patients During an Outbreak: A Multicenter Observational Study

Chen, Guan‐Jhou; Chen, Nan-Yu; Liou, Bo-Huang; Wang, Ning‐Chi; Yang, Chia‐Jui; Huang, Shiang‐Fu; Lin, Yi‐Chun; Chen, Tun‐Chieh; Wu, Ting‐Shu; Liu, Chun-Eng; Hung, Chien‐Ching; Lee, Yi‐Chieh; Cheng, Chien-Yu; Cheng, Shu‐Hsing; Huang, Yu‐Shan; Lee, Yuan‐Ti; Lin, Chiu‐Chu; Lin, Shih‐Ping; Hsieh, Chia Chien; Wang, Hsiu-Wen; Ho, Mao‐Wang; Liu, Chungeng; Lee, Yu-Lin; Lee, Yi-Chien; Tang, Hung‐Jen; Ku, Huei-Chun; Li, Chia‐Wen; Lee, Nan-Yao; Ko, Wen-Chien; Lu, Po‐Liang; Chen, Yen-Hsu; Lin, Hans Hsienhong; Huang, Wen-Chi; Lee, Chen‐Hsiang; Che, Tun-Chieh

doi:10.1093/cid/ciy328

Cited by 22 publications

(23 citation statements)

References 20 publications

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“…Prolongation of T‐BIL elevation was associated with older age and AH (A) after 2001 (OR 1.065, 95% CI 1.005–1.129, P = 0.032, and OR 25.866, 95% CI 5.283–126.650, P = 0.000, respectively). In a study of chronic hepatitis, coinfection with HIV was associated with a lower elevation in the transaminase level but a prolonged clinical course . Although HIV coinfection reportedly induces a host response that results in a marked reduction in viral load, it was not predictive of severe or prolonged hepatitis in this study.…”

Section: Discussioncontrasting

confidence: 64%

Characteristics of acute hepatitis A virus infection before and after 2001: A hospital‐based study in Tokyo, Japan

Kogiso

Sagawa

Oda

et al. 2019

J of Gastro and Hepatol

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Background and Aim The incidence of acute hepatitis A [AH (A)] is decreasing because of improvements in hygiene; however, cases of sporadic severe hepatitis are still being reported. We assessed the epidemiology of AH (A) in Japan. Methods This was a hospital‐based retrospective study, in which 126 AH (A) patients (96 men [76%], median age 39 [range, 19–66] years) were enrolled. Patients diagnosed with AH (A) before 2001 (n = 79) and after 2001 (n = 47) were compared. Results The incidence of AH (A) showed peaks in 1990, 1999, and 2018. After 2001, one patient had hepatitis B virus, four had human immunodeficiency virus, and three had syphilis coinfections. Before and after 2001, HAV was transmitted, respectively, by raw oysters (28% and 26%), overseas travel (19% and 28%), and sexual contact (0% and 19%) (P < 0.01). The frequencies of symptoms were appetite loss (51% and 32%), fever (63% and 81%), and diarrhea (3% and 13%) (all P < 0.05), respectively. On admission, the median levels of alanine aminotransferase (1455 and 3069 U/L) and γ‐glutamyl transpeptidase (221 and 345 U/L) were significantly higher (P < 0.01), and the prothrombin time (77.5% and 65.9%) and platelet count (22.7 and 16.4 × 10/μL) were significantly lower after 2001 (P < 0.05). A time to normalization of the bilirubin level ≥ 30 days was associated with older age and a diagnosis of AH (A) after 2001. Conclusions Outbreaks and severe AH (A) cases due to sexual transmission have been reported recently. It is necessary to examine their sexual behavior and other sexual infection.

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Section: Discussioncontrasting

confidence: 64%

Characteristics of acute hepatitis A virus infection before and after 2001: A hospital‐based study in Tokyo, Japan

Kogiso

Sagawa

Oda

et al. 2019

J of Gastro and Hepatol

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“…The epidemiological and clinical features of HEV infection may vary not only with regions of different endemicities, but also individuals with different immune status . Human immunodeficiency virus (HIV)‐positive patients have a longer duration of HAV viremia and fecal shedding and a prolonged course of acute hepatitis A . Nevertheless, the influence of HIV infection on HEV infection is not clear despite a higher seroprevalence of HEV among HIV‐positive patients .…”

mentioning

confidence: 99%

“…(4) Human immunodeficiency virus (HIV)-positive patients have a longer duration of HAV viremia and fecal shedding and a prolonged course of acute hepatitis A. (5,13) Nevertheless, the influence of HIV infection on HEV infection is not clear despite a higher seroprevalence of HEV among HIV-positive patients. (11,14) Hepatitis E is usually self-limiting within 4-6 weeks, but immunocompromised patients infected with HEV genotype 3 can develop chronic infection.…”

mentioning

confidence: 99%

Hepatitis E Virus Infections Among Human Immunodeficiency Virus–Positive Individuals During an Outbreak of Acute Hepatitis A in Taiwan

Lin

Sun

et al. 2019

Hepatology

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Hepatitis A virus (HAV) and hepatitis E virus (HEV) share the similar fecal‐oral transmission route. During an outbreak of sexually transmitted acute hepatitis A among men who have sex with men (MSM) worldwide between 2015 and 2017, we investigated the possibility of sexual transmission and related morbidity of HEV infection among human immunodeficiency virus (HIV)‐positive patients. From March 1, 2015 to August 31, 2017, anti‐HEV immunoglobulin G was retrospectively determined among 3,293 HIV‐positive patients, who were mainly MSM (87.6%) with a median CD4 count of 575 cells/μL. Prevalence and incidence of HEV infection were 3.7% (123 of 3,293) and 4.35 per 1,000 person‐years of follow‐up (PYFU), respectively, which were significantly lower compared with those of HAV infection (31.1% [996 of 3,204] and 12.61 per 1,000 PYFU, respectively). The number of patients with HEV infection did not increase with the hepatitis A epidemic. The factor associated with prevalent HEV infection was older age (per 1‐year increase, adjusted odds ratio, 1.07; 95% confidence interval, 1.05‐1.09), but neither sexual orientation nor acquisition of sexually transmitted infections was related to prevalent or incident HEV infection. Among 23 patients with incident HEV infection, 22 patients had viremia caused by HEV genotype 4. No patients had prolonged HEV viremia or clinical symptoms, and only a mild elevation of serum aminotransferase, ranging from 34 to 77 IU/L, was noted. Although 4 patients had hepatitis for a prolonged duration of between 8 and 17 months, no abdominal imaging revealed liver fibrosis or cirrhosis. Conclusion: HEV endemicity remained low among HIV‐positive patients in Taiwan during the outbreak of acute hepatitis A. Our data suggest that sexual transmission of HEV with significant morbidity of HEV infection, if any, is rare in this population.

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“…In Taiwan, an unprecedented outbreak of AHA occurred among MSM between June 2015 and December 2017 . To control the outbreak, an HAV vaccination campaign was launched in September 2015 and a subsidized HAV vaccination program was implemented in October 2016 among HIV‐positive patients and those with sexually transmitted diseases .…”

Section: Participants and Methodsmentioning

confidence: 99%

“…In Taiwan, an unprecedented outbreak of AHA occurred among MSM between June 2015 and December 2017. (20,21) To control the outbreak, an HAV vaccination campaign was launched in September 2015 and a subsidized HAV vaccination program was implemented in October 2016 among HIV-positive patients and those with sexually transmitted diseases. (22,23) Following this large-scale HAV vaccination program among at-risk populations, high serological response rates to HAV vaccination were observed and HAV vaccination was effective in preventing AHA.…”

Section: Study Settingmentioning

confidence: 99%

Early Seroreversion After 2 Doses of Hepatitis A Vaccination in Human Immunodeficiency Virus–Positive Patients: Incidence and Associated Factors

Huang

Wang

et al. 2019

Hepatology

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Serological responses (Seroresponse) and durability of hepatitis A virus (HAV) vaccination are reduced among human immunodeficiency virus (HIV)‐positive patients. Incidence of and associated factors with early seroreversion (loss of seroresponse) among HIV‐positive patients who have achieved seroresponses after two doses of HAV vaccination remain unclear. In this multicenter study, we followed HIV‐positive adults who had mounted seroresponses after completing two doses of HAV vaccination during a recent outbreak of acute hepatitis A between 2015 and 2017, a 1:4 case‐control study was conducted to identify factors associated with seroreversion. Case patients were those with seroreversion, and controls were those with similar follow‐up durations who were able to maintain seroresponses. During the study period, 49 of the 1,256 patients (3.9%) seroreverted after a median follow‐up of 611 days. In a case‐control study, seroreversion was more likely to occur in patients with a higher weight (adjusted odds ratio [aOR], 1.703; 95% confidence interval [CI], 1.292‐2.323, per 10‐kg increment) and HIV viremia at the time of vaccination (aOR, 2.922; 95% CI, 1.067‐7.924), whereas positive seroresponse at 6 months of HAV vaccination and higher CD4 lymphocyte counts at vaccination were inversely associated with early seroreversion with an aOR of 0.059 (95% CI, 0.020‐0.154) and 0.837 (95% CI, 0.704‐0.979, per 100‐cell/mm3 increment), respectively, in multivariable analyses. Conclusion: During an outbreak setting, early seroreversion following two‐dose HAV vaccination occurred in 3.9% of HIV‐positive patients. Lower and delayed seroresponses to HAV vaccination, a higher weight, and HIV viremia and lower CD4 lymphocyte counts at the time of HAV vaccination were associated with early seroreversion. Regular monitoring of seroresponse and booster vaccination might be warranted, especially in HIV‐positive adults with predictors of early seroreversion.

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Less Severe but Prolonged Course of Acute Hepatitis A in Human Immunodeficiency Virus (HIV)–Infected Patients Compared With HIV-Uninfected Patients During an Outbreak: A Multicenter Observational Study

Abstract: During an AHA outbreak, HIV-infected patients had a lower severity, but delayed resolution, of AHA than HIV-uninfected patients. Better viral suppression by cART alleviated the impact of HIV infection on the disease course of AHA in HIV-infected patients.

Cited by 22 publications

References 20 publications

Characteristics of acute hepatitis A virus infection before and after 2001: A hospital‐based study in Tokyo, Japan

Characteristics of acute hepatitis A virus infection before and after 2001: A hospital‐based study in Tokyo, Japan

Hepatitis E Virus Infections Among Human Immunodeficiency Virus–Positive Individuals During an Outbreak of Acute Hepatitis A in Taiwan

Early Seroreversion After 2 Doses of Hepatitis A Vaccination in Human Immunodeficiency Virus–Positive Patients: Incidence and Associated Factors

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