title: HAV replication in acute hepatitis with typical and atypical clinical course.
abstract: The correlation between the length of viremia as detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and the clinical course of hepatitis A virus (HAV) infection was studied. Sixty-six consecutive patients with acute hepatitis A who were admitted to hospital in two infectious disease units in southern Italy were enrolled: 57 had a self-limited course of the disease (typical course), 4 a prolonged course, and 5 relapsing hepatitis. Plasma HAV RNA was sought by RT-PCR, using primers made at 5'-NTR of HAV, designed to amplify a 273-bp fragment and detected by 2% agarose gel and by hybridization with a specific biotinylated probe. In four patients with prolonged acute hepatitis A, the plasma HAV RNA, which was positive on the day of admission to hospital, was found to be negative from day 62, 46, 84, and 105, respectively, after the onset of the symptoms. In patients with relapsing hepatitis, HAV viremia paralleled the clinical and biochemical course of disease. In all patients with a typical self-limiting course, clearance of plasma HAV RNA was observed within 20 days of the onset of symptoms. In most patients, plasma HAV viremia became undetectable before the normalization of serum aminotransferases, underlining the importance of the immune reaction in the pathogenesis of acute hepatitis A. The data also suggest that the detection of plasma HAV RNA after 20 days of illness may predict a prolonged course of the disease, but relapsing hepatitis remains unpredictable on the basis of plasma HAV determination.
authors.affiliation: Division of Infectious Diseases, Azienda Ospedaliera San Sebastiano, Caserta, Italy. evangelista.sagnelli@unina2.it
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
authors.forename: Nicola
authors.initials: N
authors.lastname: Coppola
authors.forename: Cecilia
authors.initials: C
authors.lastname: Marrocco
authors.forename: Mirella
authors.initials: M
authors.lastname: Onofrio
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Scarano
authors.forename: Anna
authors.initials: A
authors.lastname: Marotta
authors.forename: Carlo
authors.initials: C
authors.lastname: Scolastico
authors.forename: Antonio
authors.initials: A
authors.lastname: Catuogno
authors.forename: Angela
authors.initials: A
authors.lastname: Salzillo
authors.forename: Caterina
authors.initials: C
authors.lastname: Sagnelli
authors.forename: Felice
authors.initials: F
authors.lastname: Piccinino
authors.forename: Pietro
authors.initials: P
authors.lastname: Filippini
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D018450:Disease Progression; D005260:Female; D006506:Hepatitis A / Q000473:pathology / Q000503:physiopathology* / Q000821:virology*; D030041:Hepatitis A virus / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012307:Risk Factors; D014779:Virus Replication
chemical_list: D012367:RNA, Viral