Dissociation of alanine aminotransferase values in acute hepatitis A patients with and without past experience to the hepatitis B virus

Abstract

SUMMARYSerological markers and peak serum alanine aminotransferase (ALT) values of 140 in-patients with acute hepatitis, either type A (n = 90), or type B (n = 50) were prospectively assessed. In 23 out of the 90 patients with acute hepatitis A, evidence of previous experience with hepatitis B virus (HBV) was found, whereas 35 out of the 50 patients with acute hepatitis B had past contact with hepatitis A virus (HAV). The mean peak ALT values [S.D.] were significantly higher in hepatitis A patients with previous experience with HBV (1413 [704] i.u./l), when compared to those without such experience (842 [464] i.u./l, P < 0-001). Such a difference was not evident between acute hepatitis B patients, whether or not they had previous contact with HAV. We conclude that when acute hepatitis A is superimposed on past HBV infection an augmented transaminaemia, indicative of enhanced liver cell necrosis, takes place although a definite explanation is lacking. We suggest that individuals with markers of HBV infection should be early candidates for HAV immunization.

Care of the Cirrhotic Patient

“…Patients with chronic HBV who contract acute HAV have a more severe clinical course and higher death rate, especially older patients who have cirrhosis, based on epidemiologic data from the Centers for Disease Control and Prevention and large studies in Shanghai, Japan, and Greece. [63][64][65][66] Similar results were noted for HAV superinfection in 432 patients who had HCV during a 7-year period. Seven of 17 patients with acute HAV had fulminant hepatitis, and 6 died.…”

Hepatitis vaccination in patients with chronic liver disease

“…Asymptomatic HBsAg‐positive carriers might well have a clinical course similar to patients with acute hepatitis A alone. Although the Japanese study did not reveal a difference in hepatic markers of inflammation, a Greek study did 17 . Fourteen of 90 patients with acute hepatitis A had serological evidence of HBV carrier status, whilst another nine had evidence of previous infection.…”

“…Although the Japanese study did not reveal a difference in hepatic markers of inflammation, a Greek study did. 17 Fourteen of 90 patients with acute hepatitis A had serological evidence of HBV carrier status, whilst another nine had evidence of previous infection. The mean serum alanine aminotransferase levels were significantly higher in patients with evidence of current or previous HBV infection, compared with those with acute hepatitis A without the presence of HBV markers.…”

The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C

“…As described with HCV, some studies suggest that patients with chronic hepatitis B are at an increased risk of serious sequelae of HAV infection, 6,33 while others are not. 34,35 There is, however, no evidence to suggest that these patients are at an increased risk of HAV infection.…”

“…Whether or not this model is applicable to patients with other chronic liver diseases, particularly those with hepatitis B infection, remains to be elucidated. As described with HCV, some studies suggest that patients with chronic hepatitis B are at an increased risk of serious sequelae of HAV infection, 6,33 while others are not. 34,35 There is, however, no evidence to suggest that these patients are at an increased risk of HAV infection.…”