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Observational Study
. 2018 Oct 30;67(10):1595-1602.
doi: 10.1093/cid/ciy328.

Less Severe but Prolonged Course of Acute Hepatitis A in Human Immunodeficiency Virus (HIV)-Infected Patients Compared With HIV-Uninfected Patients During an Outbreak: A Multicenter Observational Study

Yu-Lin Lee  1 , Guan-Jhou Chen  2 , Nan-Yu Chen  3 , Bo-Huang Liou  4 , Ning-Chi Wang  5 , Yuan-Ti Lee  6   7 , Chia-Jui Yang  8   9 , Yu-Shan Huang  10 , Hung-Jen Tang  11   12 , Shie-Shian Huang  13 , Yi-Chun Lin  14 , Chien-Yu Cheng  14   15 , Chen-Hsiang Lee  16   17 , Tun-Chieh Chen  18   19 , Ting-Shu Wu  3 , Chun-Eng Liu  1 , Po-Liang Lu  19   20 , Chien-Ching Hung  2   21 ; Taiwan HIV Study Group
Collaborators, Affiliations
Observational Study

Less Severe but Prolonged Course of Acute Hepatitis A in Human Immunodeficiency Virus (HIV)-Infected Patients Compared With HIV-Uninfected Patients During an Outbreak: A Multicenter Observational Study

Yu-Lin Lee et al. Clin Infect Dis. .

Abstract

Background: This multicenter retrospective cohort study aimed to compare the clinical presentations and evolution of acute hepatitis A (AHA) between human immunodeficiency virus (HIV)-infected patients and HIV-uninfected counterparts during the AHA outbreak.

Methods: Clinical and laboratory data were collected from the medical records of the patients with AHA at the 14 hospitals around Taiwan between May 2015 and May 2017.

Results: A total of 297 adult patients with AHA were included during the study period. Their mean age was 31.4 years (range, 19.0-76.1 years); 93.4% were men and 58.6% were men who have sex with men. Of 265 patients with known HIV serostatus, 166 (62.6%) were HIV infected. Compared with HIV-uninfected patients, HIV-infected patients had a lower peak alanine aminotransferase (ALT) level (median, 1312 vs 2014 IU/L, P = .003), less coagulopathy (6.0% vs 16.2%, P = .007), and less hepatomegaly or splenomegaly on imaging studies, but a higher rate of delayed resolution of hepatitis (38.8% vs 21.3%, P = .009). HIV-infected patients with plasma RNA load <1000 copies/mL while receiving combination antiretroviral therapy (cART) had a higher peak ALT level (median, 1420 vs 978 IU/L, P = .006) and less delay in resolution of hepatitis (30.6% vs 48.8%, P = .047) than patients without cART or with plasma RNA load ≥1000 copies/mL.

Conclusions: During an AHA outbreak, HIV-infected patients had a lower severity, but delayed resolution, of AHA than HIV-uninfected patients. Better viral suppression by cART alleviated the impact of HIV infection on the disease course of AHA in HIV-infected patients.

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