Clinico‐Pathological Spectrum of Hepatitis A Virus‐Induced Autoimmune‐Like Hepatitis in Children

Abstract

There is limited evidence that hepatitis A virus (HAV) infection can trigger hepatic autoimmunity, but this area remains largely unexplored. This study was thus planned with the aim to compare HAV‐induced autoimmune‐like hepatitis (HAV‐ALH) with HAV‐related liver dysfunction (HAV‐acute viral hepatitis or HAV‐AVH) and classical autoimmune hepatitis (AIH). This was a retrospective review of 46 patients with HAV infection who underwent liver biopsy (including 17 cases of HAV‐ALH: diagnosis based on histopathology), and they were compared to 46 cases of age‐ and gender‐matched classical AIH. Overall, HAV cohort (n = 46) had higher prevalence of pruritus, higher bilirubin levels, higher proportion of cholestasis, lower IgG levels, higher seronegativity and lack of disease recurrence, while the classical AIH group had higher proportion/severity of interface hepatitis, fibrosis, necrosis and pseudorosetting (p < 0.05). In comparison to the classical HAV‐AVH group, HAV‐ALH group had higher AST levels, higher presence of autoantibodies, and higher prevalence of severe zone 3 perivenulitis and marked pseudorosetting on histology (p < 0.05). Also, HAV‐ALH group, in comparison to the AIH group, had more pruritus (OR 7.29, p < 0.004) and more seronegativity (41% vs. 13%, p < 0.031), while duration of illness (p < 0.003), IgG (p < 0.001) levels and liver stiffness measurement (p < 0.006) were significantly higher in AIH group (versus the HAV‐ALH and HAV‐AVH groups). Histologically, in comparison to AIH, HAV‐ALH group had significantly less interface hepatitis (OR 0.03, p < 0.001) and fibrosis (OR 0.08, p < 0.001) and significantly more cholestasis (OR 4.5, p < 0.021). HAV infection can act as a potential trigger for immune‐mediated hepatic damage, akin to drug‐induced autoimmune‐like hepatitis. Larger multicentric studies are needed to further explore this aspect.