Background: This multicenter retrospective cohort study aimed to compare the clinical presentations and evolution of acute hepatitis A (AHA) between HIV-positive patients and HIV-negative counterparts during the AHA outbreak.
Methods: Information on the demographics, clinical presentations, serial laboratory data, and abdominal imaging were collected from the medical records of the patients who received a diagnosis of AHA at the 14 designated hospitals for HIV care around Taiwan between May 2015 and May 2017.
Results: A total of 297 adult patients with AHA were included during the 2-year study period. With a mean age of 31.4 years (range, 19.0-76.1), 93.4% were males and 58.6% MSM. Of 265 patients with known HIV serostatus, 166 (62.6%) were HIV-positive. Compared with HIV-negative patients, HIV-positive patients had a lower peak alanine aminotransferase (ALT) level (median, 1312 vs 2014 IU/L, p=0.003), less coagulopathy (6.0% vs 16.2%, p=0.007), less hepatomegaly or splenomegaly on imaging studies, but delayed resolution of hepatitis (40.9% vs 21.3%, p=0.005). In the subgroup analysis, HIV-positive patients with good HIV viral suppression (plasma RNA load [PVL] < 1000 copies/ml) by combination antiretroviral therapy (cART) had a higher peak ALT level (median, 1420 vs 983 IU/L, p=0.012) and less delay in resolution of hepatitis (22.6% vs. 51.0%, p< 0.001) than patients without cART or with higher PVL.
Conclusions: During an AHA outbreak, we found that HIV-positive patients had a lower severity, but delayed resolution of AHA than HIV-negative patients. Receipt of cART with better viral suppression alleviated the impact of HIV infection on the clinical manifestations of AHA in HIV-positive patients.