Acute sporadic non-A, non-B hepatitis in Northeastern Brazil: Etiology and natural history

Abstract

In a 4-year follow-up study, patients with acute sporadic non-A, non-B (NANB) hepatitis were evaluated to determine the etiology and natural history of the disease. Acute hepatitis C virus (HCV) was detected in 13 of 43 (30%) of patients, anti-hepatitis E virus (HEV) IgG in 5 (12%), and 25 (58%) were considered non-A-E. The HCV RNA was detected in all HCV patients but none of the non-A-E cases. The initial clinical and biochemical presentation of the HCV and non-A-E cases was quite similar, although 2 of the non-A-E patients had severe disease. The 5 patients who were found to be anti-HEV IgG-reactive recovered within 6 months of follow-up. Of the 13 HCV cases, alanine transaminase (ALT) levels returned to normal in 7 (53.8%), while 6 (46.2%) continued to show abnormal ALT after 6 months of follow-up. However, 9 (69.2%) of them remained HCV-RNApositive, denoting virological/biochemical dissociation. Longterm follow-up showed a reappearance of HCV RNA in 2 of the 4 patients who were in virological remission performing 84% of chronicity rate. Acute non-A-E hepatitis patients were less likely to evolve toward chronicity, as compared with acute HCV cases (16% vs. 84%; P ‫؍‬ .0001). Only 4 (16%) of the non-A-E patients were hepatitis G virus (HGV)-RNA-positive. Concerning risk factors for acquiring parenterally transmitted viruses, tattooing was the only one that could be associated with HCV transmission (P ‫؍‬ .002). No risk factors could be identified for putative non-A-E virus transmission. Liver biopsies performed for chronic HCV patients showed a variable degree of inflammation, while the non-A-E patients presented less severe histological disease. (HEPATOLOGY 1999;30:289-293.)

Spontaneous viral clearance in patients with acute hepatitis C can be predicted by repeated measurements of serum viral load

“…Progression to chronic hepatitis occurs in 50% to 84% of cases. [1][2][3][4][5][6][7][8][9] This variation can be partly explained by the mode of transmission of HCV, viral factors, and by the ability of the host to mount a strong T-cell response to eliminate the virus. Acute HCV infection generally has a mild course, most cases are asymptomatic, and fulminant hepatic failure is very rare.…”

Bi-allelic presence of the interleukin-10 receptor 1 G330R allele is associated with cirrhosis in chronic HCV-1 infection

“…Chronic hepatitis develops in 33-84% of patients with acute hepatitis C. [1][2][3][4] Once, chronicity has established, about one-third of patients develop liver cirrhosis within 15-25 years 5,6 with an annual risk of hepatocellular carcinoma in 1-4% in cirrhotic livers. [7][8][9] Several factors such as alcohol abuse, coinfection with HBV or HIV, gender or age at infection determine the highly variable course of liver disease in hepatitis C virus (HCV) infection.…”

Hepatitis E Virus Immunoglobulin G Antibodies in Different Populations in Campinas, Brazil

“…Acute viral hepatitis cases possibly associated with HEV have been reported in central (27) and northeastern Brazil (18,19). In southeastern Brazil, HEV antibodies have been detected in health care workers and dialysis patients (6).…”

“…HEV infection has already been detected in the Amazon basin among gold miners (17) and isolated communities (26). Acute viral hepatitis cases possibly associated with HEV have been reported in central (27) and northeastern Brazil (18,19). In southeastern Brazil, HEV antibodies have been detected in health care workers and dialysis patients (6).…”