PROTRACTED COURSE OF HEPATITIS-A IN ADULT S

Objective. - The aim of this study was to determine the clinical and v irological characteristics of patients with type A viral hepatitis and a protracted course. Methods. - Twenty-seven patients with hepatitis A virus and elevated serum ALT levels for more than 6 months were stud ied. Patients were tested for hepatitis C and E virus using consented serums. Results. - A biological relapse was defined by a decrease of t he serum ALT levels greater than or equal to 50% followed by a greater than or equal to 50% increase in the minimal value. Biological relaps es occurred in all patients. The median time between the onset of the disease and the first relapse was 87 days. During relapse, jaundice an d ascites were present in five and one patients, respectively. All pat ients recovered. Serum aminotransferase activities returned to the nor mal range in a median of 230 days. None of the 17 tested patients had hepatitis C virus antibodies. Sixteen patients were tested for hepatit is E virus antibodies; 8 were positive for IgG and one for IgM. Sixtee n control patients with acute hepatitis A of short duration, matched f or date and country of contamination, were also tested for antibodies to hepatitis E virus; II were positive for IgG and none for IgM. Concl usion. - A protracted course of type A viral hepatitis is characterise d by relapses with or without symptoms. The high frequency of a positi ve test for hepatitis E IgG associated with a negative test for IgM in patients with and without a protracted course does nor suggest that h epatitis E virus plays a role in patients with a protracted course. Th ese positive results might be due to either false positive results or to past contamination.