Clinical and virological improvement of hepatitis B virus-related or hepatitis C virus-related chronic hepatitis with concomitant hepatitis A virus infection.
BACKGROUND
We evaluated the clinical and virological characteristics of hepatitis A virus infection in persons concomitantly infected with hepatitis B virus (HBV) or hepatitis C virus (HCV).


METHODS
We enrolled 21 patients with acute hepatitis A and chronic hepatitis with no sign of liver cirrhosis, 13 patients who were positive for hepatitis B surface antigen (case B group), 8 patients who were anti-HCV positive (case C group), and 21 patients with acute hepatitis A without a preexisting liver disease (control A group). Two control groups of patients with chronic hepatitis B (control B group) or C (control C group) were also chosen. All control groups were pair-matched by age and sex with the corresponding case group.


RESULTS
Fulminant hepatitis A was never observed, and hepatitis A had a severe course in 1 patient in the case B group and in 1 patient in the control A group. Both patients recovered. On admission, HBV DNA was detected in 1 patient in the case B group (7.7%) and in 13 patients (50%) in the control B group; HCV RNA was found in no patient in the case C group and in 16 patients (81.2%) in the control C group. Of 9 patients in the case B group who were followed up for 6 months, 3 became negative for hepatitis B surface antigen and positive for hepatitis B surface antibody, 2 remained positive for hepatitis B surface antigen and negative for HBV DNA, and 4 became positive for HBV DNA with a low viral load [corrected] Of 6 patients in the case C group who were followed up for 6 months, 3 remained negative for HCV RNA, and 3 had persistently low viral loads.


CONCLUSIONS
Concomitant hepatitis A was always self-limited, associated with a marked inhibition of HBV and HCV genomes, and possibly had a good prognosis for the underlying chronic hepatitis.
Sagnelli
Evangelista
E
Division of Infectious Diseases, Azienda Ospedaliera San Sebastiano, Caserta, Italy. evangelista.sagnelli@unina2.it
Coppola
Nicola
N
Pisaturo
Mariantonietta
M
Pisapia
Raffaella
R
Onofrio
Mirella
M
Sagnelli
Caterina
C
Catuogno
Antonio
A
Scolastico
Carlo
C
Piccinino
Felice
F
Filippini
Pietro
P
D000293:Adolescent; D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006506:Hepatitis A / Q000150:complications*; D035921:Hepatitis A Antigens / Q000097:blood; D006509:Hepatitis B / Q000150:complications*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
D004279:DNA, Viral; D035921:Hepatitis A Antigens; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral