Hepatitis A virus infection suppresses hepatitis C virus replication and may lead to clearance of HCV.
OBJECTIVE
The significance of hepatitis A virus (HAV) super-infection in patients with chronic hepatitis C had been a matter of debate. While some studies suggested an incidence of fulminant hepatitis A of up to 35%, this could not be confirmed by others.


METHODS
We identified 17 anti-HCV-positive patients with acute hepatitis A from a cohort of 3170 anti-HCV-positive patients recruited at a single center over a period of 12 years.


RESULTS
Importantly, none of the anti-HCV-positive patients had a fulminant course of hepatitis A. HCV-RNA was detected by PCR in 84% of the anti-HCV-positive/anti-HAV-IgM-negative patients but only in 65% of anti-HCV-positive patients with acute hepatitis A (p=0.03), indicating suppression of HCV replication during hepatitis A. Previous HAV infection had no effect on HCV replication. After recovery from hepatitis A, an increased HCV replication could be demonstrated for 6 out of 9 patients with serial quantitative HCV-RNA values available while 2 patients remained HCV-RNA negative after clearance of HAV throughout follow-up of at least 2 years.


CONCLUSIONS
HAV super-infection is associated with decreased HCV-RNA replication which may lead to recovery from HCV in some individuals. Fulminant hepatitis A is not frequent in patients with chronic hepatitis C recruited at a tertiary referral center.
Deterding
Katja
K
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg Str.1, 30625 Hannover, Germany.
Tegtmeyer
Björn
B
Cornberg
Markus
M
Hadem
Johannes
J
Potthoff
Andrej
A
Böker
Klaus H W
KH
Tillmann
Hans L
HL
Manns
Michael P
MP
Wedemeyer
Heiner
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000502:physiology*; D006506:Hepatitis A / Q000150:complications / Q000821:virology*; D035922:Hepatitis A Antibodies / Q000276:immunology; D030041:Hepatitis A virus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000821:virology*; D018937:Hepatitis C Antibodies / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000235:genetics; D012189:Retrospective Studies; D015163:Superinfection / Q000821:virology*; D013997:Time Factors; D014762:Viral Interference; D014779:Virus Replication / Q000502:physiology*
D035922:Hepatitis A Antibodies; D018937:Hepatitis C Antibodies; D012367:RNA, Viral