Yu-Lin Lee1, Guan-Jhou Chen2, Nan-Yu Chen3, Bo-Huang Liou4, Ning-Chi Wang5, Yuan-Ti Lee6,7, Chia-Jui Yang8,9, Yu-Shan Huang10, Hung-Jen Tang11,12, Shie-Shian Huang13, Yi-Chun Lin14, Chien-Yu Cheng14,15, Chen-Hsiang Lee16,17, Tun-Chieh Chen18,19, Ting-Shu Wu3, Chun-Eng Liu1, Po-Liang Lu19,20, Chien-Ching Hung2,21. 1. Department of Internal Medicine, Changhua Christian Hospital, Taipei. 2. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei. 3. Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan. 4. Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, National Defense Medical Center, Taipei. 5. Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei. 6. School of Medicine, Chung Shan Medical University, Taichung. 7. Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung. 8. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City. 9. School of Medicine, National Yang-Ming University, Taipei. 10. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch. 11. Department of Internal Medicine, Chi Mei Medical Center, Tainan. 12. Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan. 13. Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Taipei. 14. Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taipei. 15. School of Public Health, National Yang-Ming University, Taipei. 16. Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taipei. 17. Chang Gung University College of Medicine, Taipei. 18. Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Taipei. 19. Department of Internal Medicine, Kaohsiung Medical University Hospital, Taipei. 20. College of Medicine, Kaohsiung Medical University, Taipei. 21. Department of Parasitology, National Taiwan University College of Medicine, Taipei.
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.
Background: This multicenter retrospective cohort study aimed to compare the clinical presentations and evolution of acute hepatitis A (AHA) between human immunodeficiency virus (HIV)-infectedpatients 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-uninfectedpatients, HIV-infectedpatients 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-infectedpatients 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-infectedpatients had a lower severity, but delayed resolution, of AHA than HIV-uninfectedpatients. Better viral suppression by cART alleviated the impact of HIV infection on the disease course of AHA in HIV-infectedpatients.
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