Original Articles: Viral Hepatitis

OCD

HEPATOLOGY September 2003 . Volume 38 . Number 3 Viral and clinical factors associated with the fulminant course of hepatitis A infection Guilhermo Rezende1 Anne Marie Roque-Afonso2 Didier Samuel1 ,Michele Gigou1 ,Elisabeth Nicand3 Virginie Ferre4,Elisabeth Dussaix2 Henri Bismuth1 ,Cyrille Fray1 Abstract Fulminant hepatitis is a severe complication of hepatitis A virus infection. Its mechanism is unknown. Liver transplantation can be necessary, but spontaneous recovery is frequent. There are no data on the level of viral replication according to the clinical form of hepatitis A. We reviewed the files of 50 patients with acute hepatitis A. Nineteen patients had fulminant hepatitis (defined by encephalopathy and factor V <50%), and, from them, 10 patients underwent transplantation. Hepatitis A virus (HAV) RNA was quantified by real-time PCR on sera obtained at admission. The genotype was determined by phylogenetic analysis of HAV RNA. HAV RNA was detected in serum by RT-PCR in 39 out of 50 patients. Encephalopathy and low factor V level were significantly related to female gender, HAV PCR negativity (9/19 vs. 5/31, respectively; P = .03), a low serum HAV RNA level (log, 3.6 ± 0.6 vs. 4.4 ± 0.9, respectively; P = .02), genotypes other than IA, and acetaminophen intake. In multivariate analysis, low or undetectable HAV viral load and a high bilirubin level were independently associated with both low factor V levels and fulminant hepatitis and also with death or transplantation. In conclusion, HAV-related liver failure is due to an excessive host response associated with a marked reduction in viral load. Serum HAV RNA assay could be of help in the management of severe hepatitis A. (HEPATOLOGY 2003;38:613-618.) Publishing and Reprint Information From the 1Centre Hépato-Biliaire, Equipe Propre de l'Institut National de la Santé et de la Recherche Médicale No. 9941, Unité propre de recherche de l'enseignement supérieur (UPRES) No. 3541, Formation de recherche associée à l'Association Claude Bernard, Villejuif; 2Laboratoire de Virologie, Centre National de Référence de l'Hépatite A, Hôpital Paul Brousse, Villejuif; 3Service de Santé des Armées, Hôpital d'instruction des Armées du Val-de-Grâce, Paris; and 4Laboratorie de Virologie UPRES-EA1156, Institut de Biologie, Centre Hospitalier Regional Universitaire de Nantes, Nantes, France. Received December 30, 2002. Accepted June 2, 2003. Address reprint requests to: Cyrille Féray, Hôpital Paul Brousse,14 av Paul Vaillant-Couturier, 94800 Villejuif, France. E-mail: [email protected] Copyright © 2003 by the American Association for the Study of Liver Diseases. 0270-9139/03/3803-0011$30.00/0 doi:10.1053/jhep.2003.50366