High and persistent excretion of hepatitis A virus in immunocompetent patients

Abstract

The duration and level of virus excretion in blood and faeces of patients with hepatitis A virus (HAV) infection were studied in relation to levels of alanine aminotransferase (ALT), disease severity and HAV genotype. Clinical data, blood and faeces were collected from 27 patients with acute hepatitis A (median age: 33 years) for a maximum of 26 weeks. Single blood donations from 55 other patients with acute HAV (median age: 32 years) were also used. Virus loads were quantified by competitive nested RT-PCR. HAV was excreted in faeces for a median period of 81 days after disease onset, with 50% of patients still excreting high levels at Day 36 (2 Â 10 6 -2 Â 10 8 copies/ml faeces suspension). Viraemia was detected, but not quantifiable, for a median period of 42 days. In the first 10 days of illness, higher ALT levels were correlated with higher viraemia levels. Comparison of patients infected with genotype 1a with those infected with type 1b did not differ significantly in terms of the duration of HAV excretion or jaundice. In conclusion, faecal excretion of HAV is at a high titre in the first month, perhaps making patients infectious for a longer period than assumed currently. Blood banks should be aware that viraemia may be present for more than 1 month, and genotype did not affect the duration of virus excretion or jaundice.

Prolonged Fecal Shedding of Hepatitis E Virus (HEV) during Sporadic Acute Hepatitis E: Evaluation of Infectivity of HEV in Fecal Specimens in a Cell Culture System

“…Therefore, one possible explanation is that protracted fecal shedding of HEV in patient 1 was attributable to impaired host immunity at the initiation of hemodialysis and during maintenance hemodialysis. However, high and persistent excretion of HAV by immunocompetent patients has been reported (60), and transient, short-term viremia of HEV was observed in three hemodialysis patients who acquired subclinical HEV infection (31), suggesting that it is important to consider an alternative explanation for the obtained results. HEV in the fecal suspension obtained from patient 1 on day 22 (JE03-1760F) could grow efficiently in our cell culture system, reaching a high titer of up to 10 8 copies/ml, and HEV progeny released in the culture medium were successfully passaged five times in culture cells (55).…”

Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation

“…In contrast to hepatitis B and C viruses, HAV is not typically associated with a prolonged infectious carrier state ( 11 ). Nonetheless, this case report, and scant longitudinal studies in the literature, demonstrate the potential for ongoing transmission.…”

“…Nonetheless, this case report, and scant longitudinal studies in the literature, demonstrate the potential for ongoing transmission. In published longitudinal studies, HAV viremia persisted for median periods of 22–42 days in immunocompetent persons and 256–490 days in immunocompromised persons ( 11 , 12 ). Similar findings have been published of persistent viral shedding in feces with median days of detection after symptom onset of 81–127 days ( 11 ).…”

“…In published longitudinal studies, HAV viremia persisted for median periods of 22–42 days in immunocompetent persons and 256–490 days in immunocompromised persons ( 11 , 12 ). Similar findings have been published of persistent viral shedding in feces with median days of detection after symptom onset of 81–127 days ( 11 ). The level and length of HAV infection and fecal shedding make the carrier a potential continuing infectious source of the virus, which occurred in this case.…”

Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: A review

“…In the general population, stool shedding of HAV antigen can be detected 19 d before the peak elevation of ALT levels and continue for at least 25 d[105] and even up to 80 d[106]. The duration of viremia is estimated to last around 20 to 40 d[25,106,107] and even longer than 3 mo[108].…”