title: Hepatitis A viral load in relation to severity of the infection.
abstract: A correlation between hepatitis A virus (HAV) genomes and the clinical severity of hepatitis A has not been established. The viral load in sera of hepatitis A patients was examined to determine the possible association between hepatitis A severity and HAV replication. One hundred sixty-four serum samples from 91 Japanese patients with sporadic hepatitis A, comprising 11 patients with fulminant hepatitis, 10 with severe acute hepatitis, and 70 with self-limited acute hepatitis, were tested for HAV RNA. The sera included 83 serial samples from 20 patients. Viral load was measured by real-time RT-PCR. The detection rates of HAV RNA from fulminant, severe acute, and acute hepatitis were 10/11 (91%), 10/10 (100%), and 55/70 (79%), respectively. Mean values of HAV RNA at admission were 3.48 ± 1.30 logcopies/ml in fulminant, 4.19 ± 1.03 in severe acute, and 2.65 ± 1.64 in acute hepatitis. Patients with severe infection such as fulminant hepatitis and severe acute hepatitis had higher initial viral load than patients with less severe infection (P < 0.001). Viremia persisted for 14.2 ± 5.8 days in patients with severe infection and 21.4 ± 10.6 days in those with acute hepatitis after clinical onset (P = 0.19). HAV RNA was detectable quantitatively in the majority of the sera of hepatitis A cases during the early convalescent phase by real-time PCR. Higher initial viral replication was found in severely infected patients. An excessive host immune response might follow, reducing the viral load rapidly as a result of the destruction of large numbers of HAV-infected hepatocytes, and in turn severe disease might be induced.
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan. fujiwara-cib@umin.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Kojima
authors.forename: Shin
authors.initials: S
authors.lastname: Yasui
authors.forename: Koichiro
authors.initials: K
authors.lastname: Okitsu
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yonemitsu
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006506:Hepatitis A / Q000175:diagnosis* / Q000821:virology; D030041:Hepatitis A virus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D007564:Japan; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000097:blood; D012720:Severity of Illness Index; D019562:Viral Load; D014779:Virus Replication
chemical_list: D012367:RNA, Viral