Comparison of the Clinical Features of Hepatitis A between HBsAg-Positive and HBsAg-Negative Patients

Kim, Kwang Min; Eo, Sung June; Gwak, Geum Youn; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Yoo, Byung Chul; Paik, Seung Woon

doi:10.5009/gnl.2011.5.4.500

Cited by 5 publications

(6 citation statements)

References 20 publications

(19 reference statements)

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“…The seroprevalence of HAV infection in patients with chronic liver diseases is similar to that in general population by age ( 30 , 31 ). It has been reported that the clinical features of hepatitis A are severe in patients with chronic HBV infection ( 32 , 33 ). However, the clinical impact of chronic hepatitis B on the prognosis of hepatitis A is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…However, the clinical impact of chronic hepatitis B on the prognosis of hepatitis A is still controversial. Kim et al ( 33 ) reported that acute hepatitis A superimposed on chronic HBV infection is associated with serious morbidity and mortality including acute liver failure compared with acute hepatitis alone. Our data revealed that the prevalence of HBsAg in the study population was 3.7%, which is a similar rate in young Korean adults.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics and Outcomes of Acute Hepatitis A in Korea: A Nationwide Multicenter Study

et al. 2014

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The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Acute Hepatitis A in Korea: A Nationwide Multicenter Study

et al. 2014

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“…However, most of these studies were limited due to small sample sizes. In contrast, some other reports indicated that patients with acute hepatitis A on chronic hepatitis B had higher peak laboratory abnormalities and more severe outcomes than patients with acute hepatitis A alone, including higher fatality rates (ranging from 6‐ to 59‐fold higher) and fulminant hepatitis (ranging from 7‐ to 22‐fold higher) [Hadler, 1991; Yao, 1991; Kim et al, 2010; Kim et al, 2011]. However, some of these results were calculated from an assumed data not based on the actual investigation [Hadler, 1991; Yao, 1991], or some were conducted in tertiary hospitals, to which more severe patients are referred for liver transplantation or intensive care [Kim et al, 2010, 2011].…”

Section: Discussionmentioning

confidence: 97%

“…As increasing age is associated with an increasing risk for severe acute hepatitis A with complications, stratified analysis for this kind of confounding factor should be needed. In two recent large series reported that HAV‐associated acute liver failure occurred more frequently in HBsAg‐positive patients than in HBsAg‐negative patients as much as 9–22 folds, the age of HBsAg‐positive patients was higher than HBsAg‐negative patients [Kim et al, 2010, 2011]. Finally, this study addressed the underlying chronic hepatitis B state of patients with acute hepatitis A on chronic hepatitis B, which has been not described in most of the previous studies.…”

Section: Discussionmentioning

confidence: 99%

Does chronic hepatitis B infection affect the clinical course of acute hepatitis A?

Shin

Moh

Jung

et al. 2012

Journal of Medical Virology

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The impact of chronic hepatitis B on the clinical outcome of acute hepatitis A remains controversial. The aim of present study was to evaluate the clinical characteristics of acute hepatitis A in cases with underlying chronic hepatitis B compared to cases of acute hepatitis A alone. Data on 758 patients with acute hepatitis A admitted at two university-affiliated hospitals were reviewed. Patients were classified into three groups: group A, patients with both acute hepatitis A and underlying chronic hepatitis B (n = 27); group B, patients infected by acute hepatitis A alone whose sexes and ages were matched with patients in group A (n = 54); and group C, patients with acute hepatitis A alone (n = 731). None of the demographic features of group A were significantly different from those of group B or C, except for the proportion of males and body weight, which differed from group C. When comparing to group B, clinical symptoms were more frequent, and higher total bilirubin and lower albumin levels were observed in group A. When comparing to group C, the albumin levels were lower in group A. There were no differences in the duration of hospital stay, occurrence of acute kidney injury, acute liver failure, prolonged cholestasis, or relapsing hepatitis. This study revealed that clinical symptoms and laboratory findings were less favorable for patients with acute hepatitis A and chronic hepatitis B compared to those with acute hepatitis A alone. However, there were no differences in fatal outcomes or serious complications.

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“…During the methodological quality assessment, potential for bias was assigned to eleven case-control studies (Appendix 2). In Chironna et al (2012), Ciccozzi et al (2002), Hellara et al (2014), Mele et al (1997), Kim et al (2011) and Tosti et al (2008), the "controls/non-ill people" were affected by hepatitis B or C, while in Delarocque-Astagneau et al (2012) and Masia et al (2004), the controls were hepatitis E positive. In Gammie and Wyn-Jones (1997), the odds of acquiring hepatitis A from "being a surfer" was compared against "being a windsurfer", instead of "not being a surfer".…”

Section: Descriptive Statisticsmentioning

confidence: 99%

Risk factors for sporadic hepatitis A infection: A systematic review and meta-analysis

Thébault

Roque–Afonso

Kooh

et al. 2021

Microbial Risk Analysis

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Hepatitis A virus (HAV) is responsible for common acute viral hepatitis worldwide. Improvement in sanitation and use of efficient vaccines have reduced HAV incidence in developed countries. However, naive adult population are most susceptible to severe outcomes, and high endemic areas persist in developing regions. The transmission of HAV through the fecal-oral route is established. However, considering evolving consumption habits and global market exchange of food, investigations on risk factors associated with HAV infection are needed. Thus, a systematic review and a meta-analysis of case-control, cohort and transversal studies was performed to determine the main risk factors associated with sporadic HAV infection. Relevant scientific articles were identified through systematic literature search and subjected to a methodological quality assessment. Mixed-effects meta-analyses models were adjusted by population type to appropriate data partitions. HAV infections are defined by serological testing. The quality assessment stage selected 78 studies investigating risk factors for sporadic infections with hepatitis A conducted between 1985 and 2013. This meta-analysis confirmed that HAV infections are mostly related to inter-human transmissions, either due to contact with an ill person, through oral-anal sex practice, or lack of personal hygiene. Travel to endemic countries, occupational exposure such as working in child daycare, and exposure to wastewater were associated with HAV infection. As HAV can persist in the environment, it was not surprising that consumption of untreated drinking water, shellfish consumed raw, and crop products were risk factors. Food contamination could be due to the use of contaminated water (fruits, vegetables) or originate from infected food handlers at every point of the food chain (from picking to serving). Eating or drinking outside were associated with HAV infection. A lack of recent case-control studies was identified, with only three studies eligible between 2011 and 2017. Case-control studies required a more precise definition of risk factors such as type of crop product, and storing/preparation information (e.g. washed, frozen). The frequency of consumption or duration of environmental exposure could also better inform relationship between exposure and risk of infection. In a context of epidemiological change of HAV, international travel and trade of foods, future case-control studies are needed and should focus on populations at risk of severe infections and acute cases.

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Comparison of the Clinical Features of Hepatitis A between HBsAg-Positive and HBsAg-Negative Patients

Cited by 5 publications

References 20 publications

Clinical Characteristics and Outcomes of Acute Hepatitis A in Korea: A Nationwide Multicenter Study

Clinical Characteristics and Outcomes of Acute Hepatitis A in Korea: A Nationwide Multicenter Study

Does chronic hepatitis B infection affect the clinical course of acute hepatitis A?

Risk factors for sporadic hepatitis A infection: A systematic review and meta-analysis

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