Viral Hepatitis
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 7, 2006; 12(29): 4683-4688
Published online Aug 7, 2006. doi: 10.3748/wjg.v12.i29.4683
Virological course of hepatitis A virus as determined by real time RT-PCR: Correlation with biochemical, immunological and genotypic profiles
Zahid Hussain, Bhudev C Das, Syed A Husain, Sunil K Polipalli, Tanzeel Ahmed, Nargis Begum, Subhash Medhi, Alice Verghese, Mohammad Raish, Apiradee Theamboonlers, Yong Poovorawan, Premashis Kar
Zahid Hussain, Sunil K Polipalli, Tanzeel Ahmed, Nargis Begum, Subhash Medhi, Premashis Kar, PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India
Bhudev C Das, Division of Molecular Oncology, Institute of Cytology and Preventive Oncology, (ICMR), Noida, Sector 39, Uttar Pradesh, India
Zahid Hussain, Syed A Husain, Tanzeel Ahmed, Nargis Begum, Mohammad Raish, Human Genetics Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
Alice Verghese, Advance Center for AIDS, National Institute of Communicable Diseases, New Delhi 110041, India
Apiradee Theamboonlers, Yong Poovorawan, Viral Hepatitis Research Unit, Department of Pediatric, Faculty of Medicine, Chulalolongkorn University and Hospital, Rama IV Road, Bangkok 10330, Thailand
Correspondence to: Dr. Premashis Kar, Room No. 111, Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India. hussainzahep@gmail.com
Telephone: +91-11-23230132 Fax: +91-11-23230132
Received: March 11, 2006
Revised: March 28, 2006
Accepted: April 21, 2006
Published online: August 7, 2006
Abstract

AIM: To undertake analysis of hepatitis A viral load, alanine aminotransferase (ALT), and viral genotypes with duration of viremia, and to correlate these parameters with CD4+/ CD8+ lymphocyte populations that control cell-mediated immunity.

METHODS: Cell counts were carried out using fresh whole blood collected in EDTA vials using a fluorescence activated cell sorter. Hepatitis A virus (HAV) RNA was extracted from blood serum, reverse transcribed into cDNA and quantified by Real-Time polymerase chain reaction and was genotyped.

RESULTS: Among 11 patients, 10 could be analyzed completely. Of these, 3 had severe acute hepatitis (s-AH) and the remainder had a self-limited acute hepatitis A (AHA), with one patient with fulminant disease (encephalopathy Grade IV) dying on the 4th d. The ALT level was significantly higher both in AHA (1070.9 ± 894.3; P = 0.0014) and s-AH (1713.9 ± 886.3; P = 0.001) compared to normal controls (23.6 ± 7.2). The prothrombin time in s-AH patients (21.0 ± 2.0; P = 0.02) was significantly higher than in AHA (14.3 ± 1.1; P = 0.44). The CD4+/CD8+ ratio in AHA patients (1.17 ± 0.11; P = 0.22) and s-AH (0.83 ± 0.12; P = 0.0002) were lower than seen in normal healthy controls (1.52). Self-limited cases had peak viral load at the beginning of analysis while in s-AH patients this occurred at the 15th or 30th d. In acute and severe groups, one patient each belonged to genotype IA, with the remaining 8 cases belonging to genotype IIIA. The only fulminant hepatic failure case belonged to genotype IA. HAV viral load and ALT values collected during the entire course of the self-limited infection were directly correlated but this was not the case for s-AH patients.

CONCLUSION: Based on a small-scale study, the persistently higher viral load of s-AH might be due to diminished cellular immunity and hemolysis. The duration of viremia was dependent on the host, as the viral genotype had no apparent role in clinical outcome of AVH and s-AH cases.

Keywords: Viral load, Real-time PCR, Immunological response, Severe acute hepatitis, Self-limited acute hepatitis