Article Text
Abstract
BACKGROUND/AIMS The role of hepatitis C virus (HCV) in fulminant hepatitis remains controversial. This study was conducted to investigate the risk of fulminant hepatitis C in relation to HCV genotypes and concurrent infection of other viruses.
PATIENTS 109 HCV RNA positive patients from 334 consecutive cases hospitalised to a medical centre in northern Taiwan for overt acute viral hepatitis were prospectively evaluated.
METHODS HCV RNA was detected by a combined reverse transcription-polymerase chain reaction assay. HCV genotypes were analysed using a genotype specific probe based assay in the 5’ untranslated region.
RESULTS 39 patients tested positive for hepatitis B surface antigen but negative for IgM antibody to hepatitis B core antigen, indicating concurrent chronic hepatitis B virus (HBV) infection. Twelve patients were hepatitis G virus (HGV) RNA positive. Genotyping of HCV disclosed 1b in 93, 1b mixed with 2a/2c or 1b mixed with 2b in 11, and not classified in five. Serum titres of HCV RNA were <105 copies/ml in 77, 105–107 copies/ml in 25, and >107copies/ml in seven. Eleven patients (10.1%) had fulminant hepatitis as a complication. Development of fulminant hepatitis did not correlate with age and gender of the patients, concurrent HGV infection, HCV genotypes, or serum titre of HCV RNA. However, the incidence (95% confidence interval) of fulminant hepatitis in patients with underlying chronic HBV infection was 23.1% (9.9 to 36.3%), which is significantly higher than in those without (2.9% (−1.0 to 6.8%)). In 39 patients with concurrent chronic HBV infection, the clinical and virological characteristics showed no significant difference between those with fulminant hepatitis and those without.
CONCLUSIONS Acute hepatitis C in patients with concurrent chronic HBV infection is associated with a substantial risk of fulminant hepatitis.
- acute hepatitis C
- fulminant hepatitis
- hepatitis B virus
- hepatitis C virus
- hepatitis G virus
Abbreviations used in this paper
- HCV
- hepatitis C virus
- HBV
- hepatitis B virus
- HGV
- hepatitis G virus
- HAV
- hepatitis A virus
- HDV
- hepatitis D virus
- FHF
- fulminant hepatic failure
- RT-PCR
- reverse transcription-polymerase chain reaction
- NANB
- non-A non-B
- HBsAg
- hepatitis B surface antigen
- EBV
- Epstein-Barr virus
- CMV
- cytomegalovirus