title: Genotypic shift of the hepatitis A virus and its clinical impact on acute hepatitis A in Korea: a nationwide multicenter study.
abstract: BACKGROUND
  The genotypic shift of hepatitis A virus (HAV) and its correlation with clinical course has not been evaluated in acute hepatitis A (AHA).
  
  
  METHODS
  From June 2007 to May 2009, we prospectively enrolled 546 AHA patients. We performed a nested reverse transcriptase polymerase chain reaction (RT-PCR) using the serum samples in addition to phylogenetic analysis, then we compared patient clinical features.
  
  
  RESULTS
  Among 351 successfully genotyped patients, we found genotype IIIA in 178 patients (51%) and IA in 173 patients (49%). The sequences of genotype IA are identical to previously reported Korean genotype IA, and the new IIIA genotype is closely related to NOR24/Norway. We retrospectively analyzed 41 AHA samples collected from 2000 to 2006 and found that all of them were genotype IA. Patients with genotype IIIA showed significantly higher levels of aspartate aminotransferase, higher levels of alanine aminotransferase, and lower platelet counts than patients with genotype IA when comparing baseline laboratory data or peak/lowest laboratory data during the disease course. However, there were no differences in duration of hospital stay, incidence of cholestatic hepatitis, acute kidney injury, and acute liver failure, or mortality between them.
  
  
  CONCLUSIONS
  A genotypic shift of the HAV was identified in Korean AHA subjects, and genotype IIIA HAV has become endemic. Although there were significant differences in the biochemical responses of AHA between genotype IA and genotype IIIA patients, we did not detect any differences in clinical outcomes such as complications or mortality.
authors.affiliation: From the Department of Internal Medicine, Korea University College of Medicine , Seoul.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.forename: Hong Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Park
authors.forename: Myung-Seok
authors.initials: MS
authors.lastname: Lee
authors.forename: Joo Hyun
authors.initials: JH
authors.lastname: Sohn
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: So Young
authors.initials: SY
authors.lastname: Kwon
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Soon Young
authors.initials: SY
authors.lastname: Kang
authors.forename: Hyonggin
authors.initials: H
authors.lastname: An
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Song
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019353:Endemic Diseases; D005260:Female; D005838:Genotype; D006506:Hepatitis A / Q000453:epidemiology* / Q000821:virology*; D017957:Hepatitis A Virus, Human / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D010802:Phylogeny; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D056910:Republic of Korea / Q000453:epidemiology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D044967:Serum / Q000821:virology; D055815:Young Adult
chemical_list: D012367:RNA, Viral