A Comparison of Clinical Manifestations and Outcomes between Acute Sporadic Hepatitis A and Hepatitis E Infections in Thailand

Abstract

Hepatitis A virus (HAV) and hepatitis E virus (HEV) infections often present as acute hepatitis with prodromal symptoms. These infections, transmitted via the oral–enteral route, constitute significant public health challenges, particularly in developing countries with subpar sanitary systems. The aim of the study was to describe the clinical manifestations, laboratory findings, and outcomes of hepatitis A and hepatitis E infections in Thailand. We conducted a retrospective chart review and analysis of 152 patients diagnosed with acute hepatitis A or hepatitis E from January 2007 to August 2018 at Siriraj Hospital. The hepatitis E cohort was older with a greater prevalence of comorbidities (hypertension, diabetes mellitus, chronic kidney disease, chronic hepatitis B, and post-kidney transplantation status) than the hepatitis A cohort. While the majority of hepatitis A patients presented with fever (98%) and jaundice (96%), these symptoms were less pronounced in hepatitis E patients. Furthermore, hepatitis A patients exhibited significantly higher aminotransferase and total bilirubin levels. However, clinical outcomes, such as hospitalization rates, progression to acute liver failure, and mortality, were comparable across both groups. In conclusion, although the clinical manifestations of hepatitis A and hepatitis E were similar, fever and jaundice were more prevalent and aminotransferase and bilirubin levels were higher in the HAV-infected group.

Recent advances in hepatitis E virus research and the Japanese clinical practice guidelines for hepatitis E virus infection

“…241 Interestingly, in one study, the hepatitis E cohort was older with a greater prevalence of comorbidities, such as hypertension, diabetes mellitus, chronic kidney disease, chronic hepatitis B, and postkidney transplantation status, than the hepatitis A cohort. 242 A recent single-center retrospective study from Bulgaria demonstrated that men or women with HEV have 3.091-fold or 5.161-fold greater odds of having "hypertension" comorbidity than those with HAV (p = 0.032 or p = 0.049). 243 Representative factors influencing the severity of hepatitis E are shown in Table 1.…”

“…Host factors Older age 163,171 Genetic factors 192,194 Viral factors HEV viral load 174,195 HEV genotype 163,164,195 Nucleotide mutation 172,208 Other factors Existence of chronic liver disease 229,232 Existence of metabolic disease 242,250 Coinfection of HAV 244 Abbreviations: HAV, hepatitis A virus; HEV, hepatitis E virus. women and 41-year-old men) contracted HEV infection through blood transfusion.…”