Clinical

Fecal levels of hepatitis A virus remain high a month after symptom onset

Last Updated: 2006-11-24 16:30:33 -0400 (Reuters Health)

NEW YORK (Reuters Health) - At 1 month after symptom onset, high levels of hepatitis A virus (HAV) are still present in stool samples of patients with acute infection, suggesting that the infectious period is longer than previously thought, new research shows. Moreover, HAV may be present in the blood for longer than 1 month.

Previous reports have suggested that HAV-infected patients are infectious 1 to 2 weeks before and after symptom onset. However, coupled with other recent reports, the present findings suggest that the infectious period can last a month or longer after the onset of jaundice.

The current study, which is reported in the Journal of Medical Virology for November, involved an analysis of blood and fecal samples collected for up to 26 weeks from 27 patients with acute hepatitis A. In addition, 55 additional patients provided a single blood donation. All of the subjects were immunocompetent.

The median period of HAV excretion in stool was 81 days after symptom onset and half of the patients were still excreting high levels of the virus at Day 36, senior author Dr. Sylvia M. Bruisten, from the Public Health Service of Amsterdam, and colleagues note.

The median period of detectable viremia was 42 days, the report indicates.

Higher ALT levels were predictive of higher viremia, but only in the first 10 days of clinical disease. Viral genotype appeared to play no role in determining the duration of HAV excretion or jaundice.

The authors note that blood banks should be aware that HAV patients can still be viremic up to 2 months after symptom onset. They also point out that while the persistence of HAV excretion in the current study group is longer than previously thought, it is still shorter than the 106-day excretion period described in one study of patients coinfected with HIV.

J Med Virol 2006;78:1398-1405.