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1 June 2006

Volume 42, Number 11
Clinical Infectious Diseases 2006;42:1536–1543
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4211-0005$15.00
DOI: 10.1086/503840
MAJOR ARTICLE

Clinical and Virological Improvement of Hepatitis B Virus–Related or Hepatitis C Virus–Related Chronic Hepatitis with Concomitant Hepatitis A Virus Infection

Evangelista Sagnelli,1,2

Nicola Coppola,1,2

Mariantonietta Pisaturo,1,2

Raffaella Pisapia,1,2

Mirella Onofrio,1,2

Caterina Sagnelli,2

Antonio Catuogno,1

Carlo Scolastico,2

Felice Piccinino,2 and

Pietro Filippini2

1Division of Infectious Diseases, Azienda Ospedaliera San Sebastiano, Caserta, and 2Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy

Background.We evaluated the clinical and virological characteristics of hepatitis A virus infection in persons concomitantly infected with hepatitis B virus (HBV) or hepatitis C virus (HCV).

Methods.We enrolled 21 patients with acute hepatitis A and chronic hepatitis with no sign of liver cirrhosis, 13 patients who were positive for hepatitis B surface antigen (case B group), 8 patients who were anti‐HCV positive (case C group), and 21 patients with acute hepatitis A without a preexisting liver disease (control A group). Two control groups of patients with chronic hepatitis B (control B group) or C (control C group) were also chosen. All control groups were pair‐matched by age and sex with the corresponding case group.

Results.Fulminant hepatitis A was never observed, and hepatitis A had a severe course in 1 patient in the case B group and in 1 patient in the control A group. Both patients recovered.

On admission, HBV DNA was detected in 1 patient in the case B group (7.7%) and in 13 patients (50%) in the control B group; HCV RNA was found in no patient in the case C group and in 16 patients (81.2%) in the control C group. Of 9 patients in the case B group who were followed up for 6 months, 3 became negative for hepatitis B surface antigen and positive for hepatitis B surface antibody, 2 remained positive for hepatitis A surface antigen and negative for HBV DNA, and 4 became positive for HBV DNA with a low viral load. Of 6 patients in the case C group who were followed up for 6 months, 3 remained negative for HCV RNA, and 3 had persistently low viral loads.

Conclusion.Concomitant hepatitis A was always self‐limited, associated with a marked inhibition of HBV and HCV genomes, and possibly had a good prognosis for the underlying chronic hepatitis.

Received 3 November 2005; accepted 24 January 2006; electronically published 26 April 2006.

Reprints or correspondence: Prof. Evangelista Sagnelli, Dept. of Public Health, Section of Infectious Diseases, Second University of Naples, c/o Ospedale Gesù e Maria, Via D. Cotugno 1, 80135 Naples, Italy ().

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