title: 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 x 10(6) - 2 x 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.
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam, 1000 CE, Amsterdam, The Netherlands.
authors.forename: Grace M S
authors.initials: GM
authors.lastname: Tjon
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Anneke
authors.initials: A
authors.lastname: van den Hoek
authors.forename: Sylvia
authors.initials: S
authors.lastname: Esman
authors.forename: Clementine J
authors.initials: CJ
authors.lastname: Wijkmans
authors.forename: Christian J P A
authors.initials: CJ
authors.lastname: Hoebe
authors.forename: Bert
authors.initials: B
authors.lastname: Wolters
authors.forename: Corien
authors.initials: C
authors.lastname: Swaan
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.forename: Nicole
authors.initials: N
authors.lastname: Dukers
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: Bruisten
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005243:Feces / Q000821:virology; D005260:Female; D006506:Hepatitis A / Q000235:genetics / Q000276:immunology* / Q000821:virology*; D030041:Hepatitis A virus / Q000502:physiology*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D013997:Time Factors; D019562:Viral Load; D017201:Virus Shedding / Q000502:physiology*