Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C

Sandro Vento, Tiziana Garofano, Carlo Renzini, Francesca Cainelli, Ferruccio Casali, Giancarlo Ghironzi, Teresa Ferraro, Ercole Concia

Research output: Contribution to journalArticle

609 Citations (Scopus)

Abstract

Background: Hepatitis A virus (HAV) infection rarely causes fulminant hepatic failure in people with no underlying liver disease. There are limited data on the course of this infection in patients with chronic hepatitis B and chronic hepatitis C. Methods: We prospectively followed, from June 1990 to July 1997, 595 adults with biochemical and histologic evidence of chronic hepatitis B (163 patients) or chronic hepatitis C (432 patients) who were seronegative for HAV antibodies. All were tested every four months for serum IgM and IgG antibodies to HAV. Results: Twenty-seven patients acquired HAV superinfection, 10 of whom had chronic hepatitis B and 17 of whom had chronic hepatitis C. One of the patients with chronic hepatitis B, who also had cirrhosis, had marked cholestasis (peak serum bilirubin level, 28 mg per deciliter [479 μmol per liter]); the other nine had uncomplicated courses of hepatitis A. Fulminant hepatic failure developed in seven of the patients with chronic hepatitis C, all but one of whom died. The other 10 patients with chronic hepatitis C had uncomplicated courses of hepatitis A. Conclusions: Although most patients with chronic hepatitis B who acquired HAV infection had an uncomplicated course, patients with chronic hepatitis C had a substantial risk of fulminant hepatitis and death associated with HAV superinfection. Our data suggest that patients with chronic hepatitis C should be vaccinated against hepatitis A.

Original languageEnglish
Pages (from-to)286-290
Number of pages5
JournalNew England Journal of Medicine
Volume338
Issue number5
DOIs
Publication statusPublished - Jan 29 1998
Externally publishedYes

Fingerprint

Hepatitis A virus
Superinfection
Chronic Hepatitis C
Hepatitis
Chronic Hepatitis B
Hepatitis A
Hepatitis A Antibodies
Acute Liver Failure
Virus Diseases
Cholestasis
Serum
Bilirubin
Immunoglobulin M
Liver Diseases
Fibrosis
Immunoglobulin G

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. / Vento, Sandro; Garofano, Tiziana; Renzini, Carlo; Cainelli, Francesca; Casali, Ferruccio; Ghironzi, Giancarlo; Ferraro, Teresa; Concia, Ercole.

In: New England Journal of Medicine, Vol. 338, No. 5, 29.01.1998, p. 286-290.

Research output: Contribution to journalArticle

Vento, Sandro ; Garofano, Tiziana ; Renzini, Carlo ; Cainelli, Francesca ; Casali, Ferruccio ; Ghironzi, Giancarlo ; Ferraro, Teresa ; Concia, Ercole. / Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. In: New England Journal of Medicine. 1998 ; Vol. 338, No. 5. pp. 286-290.
@article{b950847461c54f75b4c9e353e7290284,
title = "Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C",
abstract = "Background: Hepatitis A virus (HAV) infection rarely causes fulminant hepatic failure in people with no underlying liver disease. There are limited data on the course of this infection in patients with chronic hepatitis B and chronic hepatitis C. Methods: We prospectively followed, from June 1990 to July 1997, 595 adults with biochemical and histologic evidence of chronic hepatitis B (163 patients) or chronic hepatitis C (432 patients) who were seronegative for HAV antibodies. All were tested every four months for serum IgM and IgG antibodies to HAV. Results: Twenty-seven patients acquired HAV superinfection, 10 of whom had chronic hepatitis B and 17 of whom had chronic hepatitis C. One of the patients with chronic hepatitis B, who also had cirrhosis, had marked cholestasis (peak serum bilirubin level, 28 mg per deciliter [479 μmol per liter]); the other nine had uncomplicated courses of hepatitis A. Fulminant hepatic failure developed in seven of the patients with chronic hepatitis C, all but one of whom died. The other 10 patients with chronic hepatitis C had uncomplicated courses of hepatitis A. Conclusions: Although most patients with chronic hepatitis B who acquired HAV infection had an uncomplicated course, patients with chronic hepatitis C had a substantial risk of fulminant hepatitis and death associated with HAV superinfection. Our data suggest that patients with chronic hepatitis C should be vaccinated against hepatitis A.",
author = "Sandro Vento and Tiziana Garofano and Carlo Renzini and Francesca Cainelli and Ferruccio Casali and Giancarlo Ghironzi and Teresa Ferraro and Ercole Concia",
year = "1998",
month = "1",
day = "29",
doi = "10.1056/NEJM199801293380503",
language = "English",
volume = "338",
pages = "286--290",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "5",

}

TY - JOUR

T1 - Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C

AU - Vento, Sandro

AU - Garofano, Tiziana

AU - Renzini, Carlo

AU - Cainelli, Francesca

AU - Casali, Ferruccio

AU - Ghironzi, Giancarlo

AU - Ferraro, Teresa

AU - Concia, Ercole

PY - 1998/1/29

Y1 - 1998/1/29

N2 - Background: Hepatitis A virus (HAV) infection rarely causes fulminant hepatic failure in people with no underlying liver disease. There are limited data on the course of this infection in patients with chronic hepatitis B and chronic hepatitis C. Methods: We prospectively followed, from June 1990 to July 1997, 595 adults with biochemical and histologic evidence of chronic hepatitis B (163 patients) or chronic hepatitis C (432 patients) who were seronegative for HAV antibodies. All were tested every four months for serum IgM and IgG antibodies to HAV. Results: Twenty-seven patients acquired HAV superinfection, 10 of whom had chronic hepatitis B and 17 of whom had chronic hepatitis C. One of the patients with chronic hepatitis B, who also had cirrhosis, had marked cholestasis (peak serum bilirubin level, 28 mg per deciliter [479 μmol per liter]); the other nine had uncomplicated courses of hepatitis A. Fulminant hepatic failure developed in seven of the patients with chronic hepatitis C, all but one of whom died. The other 10 patients with chronic hepatitis C had uncomplicated courses of hepatitis A. Conclusions: Although most patients with chronic hepatitis B who acquired HAV infection had an uncomplicated course, patients with chronic hepatitis C had a substantial risk of fulminant hepatitis and death associated with HAV superinfection. Our data suggest that patients with chronic hepatitis C should be vaccinated against hepatitis A.

AB - Background: Hepatitis A virus (HAV) infection rarely causes fulminant hepatic failure in people with no underlying liver disease. There are limited data on the course of this infection in patients with chronic hepatitis B and chronic hepatitis C. Methods: We prospectively followed, from June 1990 to July 1997, 595 adults with biochemical and histologic evidence of chronic hepatitis B (163 patients) or chronic hepatitis C (432 patients) who were seronegative for HAV antibodies. All were tested every four months for serum IgM and IgG antibodies to HAV. Results: Twenty-seven patients acquired HAV superinfection, 10 of whom had chronic hepatitis B and 17 of whom had chronic hepatitis C. One of the patients with chronic hepatitis B, who also had cirrhosis, had marked cholestasis (peak serum bilirubin level, 28 mg per deciliter [479 μmol per liter]); the other nine had uncomplicated courses of hepatitis A. Fulminant hepatic failure developed in seven of the patients with chronic hepatitis C, all but one of whom died. The other 10 patients with chronic hepatitis C had uncomplicated courses of hepatitis A. Conclusions: Although most patients with chronic hepatitis B who acquired HAV infection had an uncomplicated course, patients with chronic hepatitis C had a substantial risk of fulminant hepatitis and death associated with HAV superinfection. Our data suggest that patients with chronic hepatitis C should be vaccinated against hepatitis A.

UR - http://www.scopus.com/inward/record.url?scp=0032576759&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032576759&partnerID=8YFLogxK

U2 - 10.1056/NEJM199801293380503

DO - 10.1056/NEJM199801293380503

M3 - Article

VL - 338

SP - 286

EP - 290

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 5

ER -