|Title:||Less severe but prolonged course of acute hepatitis a in Human Immunodeficiency Virus (HIV)-infected patients compared with HIV-uninfected patients during an outbreak: A multicenter observational study||Authors:||Lee Y.-L.
|Issue Date:||2018||Publisher:||Oxford University Press||Journal Volume:||67||Journal Issue:||10||Start page/Pages:||1595-1602||Source:||Clinical Infectious Diseases||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. ? The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.
|ISSN:||1058-4838||DOI:||10.1093/cid/ciy328||SDG/Keyword:||alanine aminotransferase; antiretrovirus agent; RNA; acute hepatitis A; adult; aged; antiretroviral therapy; Article; blood clotting disorder; clinical feature; cohort analysis; comparative study; disease course; disease duration; disease severity; epidemic; female; hepatosplenomegaly; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; men who have sex with men; multicenter study; observational study; priority journal; acute disease; CD4 lymphocyte count; clinical trial; complication; epidemic; hepatitis A; highly active antiretroviral therapy; male homosexuality; medical record; retrospective study; risk factor; sexual and gender minority; Taiwan; virology; virus load; young adult; Acute Disease; Adult; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Disease Outbreaks; Female; Hepatitis A; HIV Infections; Homosexuality, Male; Humans; Male; Medical Records; Retrospective Studies; Risk Factors; Sexual and Gender Minorities; Taiwan; Viral Load; Young Adult
|Appears in Collections:||醫學系|
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