Acute Hepatitis A and Hepatitis B Coinfection

Abstract

Hepatitis A (HAV) has emerged in outbreaks across the United States particularly in at-risk populations such as men who have sex with men, as well as patients with a history of drug use, homelessness, and incarceration. Immunization among these high-risk populations remains underused. In this study, we describe a case of acute HAV and hepatitis B (HBV) coinfection in an MSM patient occurring in the period of these outbreaks. Clinical resolution of acute HAV and HBV coinfection was attained by 5 months from the time of initial hospitalization without viral hepatitis treatment. This case highlights the need for increased awareness of at-risk populations for HAV and HBV infection in promoting guideline-based vaccination efforts. Initial evaluation was also negative for anti-smooth muscle antibody, rheumatoid factor, Cytomegalovirus IgM, Epstein-Barr virus DNA polymerase chain reaction, HSV1/2 IgM, and HIV Ag/Ab/RNA. He denied any medications nor supplement ingestion to suggest drug-induced liver injury. Abdominal ultrasound was normal with no biliary dilation seen to suggest extrahepatic

Acute Hepatitis A and Hepatitis B Coinfection in a Young Female: A Case Report and Literature Review

“…Positive autoimmune antibodies, such as rheumatoid factor (RF), can result in a false-positive IgM HAV test result. Negative anti-HAV IgG or negative HAV RNA confirms the false-positive condition in this instance [ 1 – 3 , 5 , 6 ].…”

“…Even though hepatitis A and B are vaccinepreventable diseases, recent studies in the United States indicate an increase in the incidence of HAV infection between 2016 and 2018, with admission and mortality rates of 67% and 2.7%, respectively. In addition, HBV estimated acute infections remained stable from 2016 to 2019; it was 20,700 patients in 2019, and the prevalence of chronic HBV infection was estimated at 1.59 million patients in the same year [1][2][3]7].…”

“…Te HBV DNA test helps detect and determine antiviral treatment's timing and monitor post-treatment follow-up. Higher HBV DNA titers correlate with hepatocellular carcinoma (HCC) and advanced disease incidence [1][2][3][4][5].…”

“…In 2015, viral hepatitis caused 1.34 million deaths worldwide, as well as tuberculosis (1.37 million), HIV infection (1.06 million), and malaria (0.44 million). Moreover, chronic hepatitis complications accounted for 96% of hepatitis-related deaths in 2015 [ 1 , 2 ].…”

Acute Viral Hepatitis Due to Co-infection With Hepatitis A and Hepatitis B in an Intravenous Drug User

“…Another study found that while over half of injection drug users tested positive for anti-HAV total antibody, none of them tested positive for anti-HAV immunoglobulin M (IgM), indicating that none had acute infection with HAV [ 11 ]. There have only been two other case reports of acute co-infection with HAV and HBV in general [ 12 , 13 ].…”