Acute, hepatitis-A super-infection in HBV carriers, or chronic liver disease related to HBV or HCV

Pramoolsinsap, Chutima; Poovorawan, Yong; Hirsch, Petra; Busagorn, N; Attamasirikul, K.

doi:10.1080/00034989958005

Cited by 30 publications

(3 citation statements)

References 23 publications

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“…Although HAV transmission is rarely blood-borne and hemophilic patients are at no greater risk of this infection than the general population, in those already chronically infected with HBV and/or HCV, an additional acute HAV infection may have additional adverse effects on chronic liver disease (37). It is therefore reasonable to recommend routine HAV vaccinations for this population in particular.…”

Section: Discussionmentioning

confidence: 99%

Co-Infection of the Hepatitis C Virus With Other Blood-Borne and Hepatotropic Viruses Among Hemophilia Patients in Poland

et al. 2016

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BackgroundThe prevalence of HCV infection in people with hemophilia is substantially higher than that in the general population (63% - 98%). Multiple transfusions and substitutive therapy have also been linked to a high risk of HBV and HIV transmission. However, the prevalence of other blood-borne viral infections in this population is less well known.ObjectivesThis study aimed to assess the prevalence of co-infection with HBV and other blood-borne viruses in Polish HCV-infected hemophiliacs.MethodsSeventy-one individuals, the majority of whom were male (94.36%), who had congenital bleeding disorders (60 had hemophilia A, five had hemophilia B, and six had other factor deficiencies) and HCV infection, which was defined as the presence of positive anti-HCV antibodies, were included in this study. The study group was divided into two subgroups according to the year in which blood donors were first tested for HBsAg in Poland. The serological markers were screened using commercially available enzyme immunoassays according to the manufacturer’s instructions. The molecular tests were performed using real-time PCR technology with commercial assays according to the manufacturer’s instructions.ResultsThe spontaneous elimination rate of HCV RNA was 29.6%. The HCV genotype 1 was detected in 28 patients (65.1%), genotype 2 in one patient (2.3%), genotype 3 in 11 patients (25.6%), genotype 4 in two patients (4.7%), and a mixed infection with genotypes 1 and 4 was detected in one person (2.3%). Fifty-three patients (74.6%) were anti-HBc positive. Among the seven HBsAg(+) patients, three individuals were HBV-DNA positive. No occult hepatitis B was detected. In six HBsAg positive patients, the HCV RNA was positive, while one patient was also infected with HIV. The prevalence rate of past infection with HAV in the study group was 30.9%, with a tendency for a higher prevalence in older patients. The prevalence of CMV and EBV infection was high and similar to that seen in the general population. All the patients were HGV and HTLV-1 negative.ConclusionsThe diagnostics and management of infections with hepatotropic viruses, particularly HBV, are neglected in hemophilic patients. All patients with coagulation disorders and a history of exposure to non-inactivated blood products should be screened for blood-borne infections. The prevalence of other potentially blood-borne viral infections exhibited a pattern similar to that observed in the general population.

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Section: Discussionmentioning

confidence: 99%

Co-Infection of the Hepatitis C Virus With Other Blood-Borne and Hepatotropic Viruses Among Hemophilia Patients in Poland

et al. 2016

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“…One-third of the patients were not tested for hepatitis A immunity, which could represent missed opportunities to provide vaccine protection, which could lead to serious clinical consequences. For example, one study found that 11 of 20 patients with acute hepatitis A and CHB developed fulminant or submassive liver necrosis, whereas 100 patients with acute hepatitis A and no underlying chronic liver disease recovered fully (17). Compared with infectious disease physicians, gastroenterologists were often remiss in their adherence to testing for HCV and HIV co-infection.…”

Section: Discussionmentioning

confidence: 99%

Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center

Johnson

Roccaro

et al. 2014

American Journal of Gastroenterology

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Objectives Adherence to the American Association for the Study of Liver Disease (AASLD) guidelines for the management of chronic hepatitis B (CHB) has not been systematically assessed. We sought to comprehensively evaluate adherence to five key areas of these guidelines. We also evaluated physician and patient factors underlying nonadherence, and predictors of nonadherence such as physician type, patient demographic factors, and phase of CHB infection. Methods Nine hundred and sixty-two adult patients were retrospectively identified. Each patient chart was reviewed in detail. The primary outcome was adherence to five areas of the AASLD guidelines: (i) timely alanine aminotransferase (ALT)/hepatitis B virus DNA level checks needed to monitor inactive carrier and immune-tolerant phases; (ii) liver biopsy to guide decisions on initiating treatment; (iii) treatment initiation when indicated; (iv) hepatocellular carcinoma (HCC) screening; (v) testing for hepatitis A virus (HAV) immunity, HIV, and hepatitis C virus (HCV) co-infections. Results Sixty percent did not undergo clinically indicated liver biopsies, largely owing to physician nonadherence. Eighty-nine percent of these missed biopsies were needed to further assess possible e-antigen-negative CHB. A high treatment initiation rate was found for the treatment eligible, but 121 patients had unclear treatment eligibility as they warranted, but did not undergo, liver biopsy. Forty-five percent did not have timely HCC screening, although gastroenterology physicians had the highest odds of adherence, and 29% did not have timely CHB lab assessment; patients seen by gastroenterologists had twice the odds compared with primary care physicians of undergoing timely lab monitoring. Thirty-five, 24, and 54% were not tested for HAV, HCV, and HIV co-infections. Conclusions Our findings show remarkably poor adherence to AASLD guidelines, particularly in the areas of liver biopsy, timely HCC and ALT monitoring, and testing for co-infection. These findings call for greater efforts to meet physician knowledge gaps, incorporation of decision support tools, and improved communication among providers.

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“…Vento et al reported that, among 10 patients with an acquired HAV superinfection and chronic HBV infection, one (10%), who had cirrhosis, had marked cholestasis [ 9 ]. Pramoolsinsap et al evaluated acute superinfection with HAV in 20 HBV asymptomatic carriers and fulminant hepatitis or submassive hepatitis in 11 (55%) of 20 HBsAg carriers [ 63 ]. A superinfection of HAV in patients with HBV occasionally leads to critical conditions in HBV carriers with or without cirrhosis, although patients with advanced fibrosis or cirrhosis are more susceptible to severe conditions [ 9 , 21 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ].…”

Section: Coinfection Of Hav With Hbvmentioning

confidence: 99%

Co-Occurrence of Hepatitis A Infection and Chronic Liver Disease

Sasaki

Masuzaki

Takahashi

et al. 2020

IJMS

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Hepatitis A virus (HAV) infection occasionally leads to a critical condition in patients with or without chronic liver diseases. Acute-on-chronic liver disease includes acute-on-chronic liver failure (ACLF) and non-ACLF. In this review, we searched the literature concerning the association between HAV infection and chronic liver diseases in PubMed. Chronic liver diseases, such as metabolic associated fatty liver disease and alcoholic liver disease, coinfection with other viruses, and host genetic factors may be associated with severe hepatitis A. It is important to understand these conditions and mechanisms. There may be no etiological correlation between liver failure and HAV infection, but there is an association between the level of chronic liver damage and the severity of acute-on-chronic liver disease. While the application of an HAV vaccination is important for preventing HAV infection, the development of antivirals against HAV may be important for preventing the development of ACLF with HAV infection as an acute insult. The latter is all the more urgent given that the lives of patients with HAV infection and a chronic liver disease of another etiology may be at immediate risk.

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Acute, hepatitis-A super-infection in HBV carriers, or chronic liver disease related to HBV or HCV

Cited by 30 publications

References 23 publications

Co-Infection of the Hepatitis C Virus With Other Blood-Borne and Hepatotropic Viruses Among Hemophilia Patients in Poland

Co-Infection of the Hepatitis C Virus With Other Blood-Borne and Hepatotropic Viruses Among Hemophilia Patients in Poland

Poor Adherence to AASLD Guidelines for Chronic Hepatitis B Management and Treatment in a Large Academic Medical Center

Co-Occurrence of Hepatitis A Infection and Chronic Liver Disease

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