Acute, hepatitis-A super-infection in HBV carriers, or chronic liver disease related to HBV or HCV

The impact of acute super-infection with hepatitis A virus (HAV) was determ ined in 20 asymptomatic carriers of the surface antigen (HBsAg) of hepatiti s B virus (HBV), eight patients with HBV-related chronic liver disease (CLD ), and four patients with CLD related to hepatitis C virus (HCV). For compa rison, 100 patients with isolated HAV infection were also studied. The HBsA g carriers and patients with CLD related to HBV or HCV were significantly o lder than the patients with isolated HAV infection, with mean (S.D.) ages o f 43.9 (14.1), 46.4 (16.0), 52.5 (8.6) and 28.4 (10.7) years, respectively (P less than or equal to 0.02). There were no significant between-group dif ferences in the baseline serum concentrations of alanine aminotransferase. All the patients with isolated HAV infection fully recovered. Fulminant or submassive hepatitis occurred in 11 (55%) of the HBsAg carriers and four (3 3%) of the 12 patients with CLD related to either HBV or HCV. Nine of the 1 5 patients with severe hepatitis died and the mortality rate among the HBsA g carriers was not significantly different from that among the CLD patients (25% v. 33%; P = 0.15). These fatal cases were all aged >50 years and were significantly older [59.0 (2.1) years] than the six severe cases who recov ered [43.2 (10.7) years] as well as the remaining 17 uncomplicated cases wi th CLD or HBsAg [40.3 (13.0) years] (P less than or equal to 0.001). The re sults indicate that acute HAV is rarely fatal in young adults but may be se vere and potentially fatal in patients with underlying chronic HBV or HCV i nfection, especially among the elderly. Vaccination against HAV should be c onsidered for the patients at high risk who are negative for anti-HAV.