Chen Nan-Yu, Liu Zhuo-Hao, Shie Shian-Sen, Chen Tsung-Hsing, Wu Ting-Shu
Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fuhsing Street, Kueishan, Taoyuan, 333, Taiwan.
Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical College and University, 5 FuSing Street, Kueishan, Taoyuan, Taiwan.
BMC Infect Dis. 2017 Jun 20;17(1):441. doi: 10.1186/s12879-017-2555-x.
Acute hepatitis A is a fecal-oral transmitted disease related to inadequate sanitary conditions. In addition to its traditional classification, several outbreaks in the men who have sex with men (MSM) population have resulted in acute hepatitis A being recognized as a sexually transmitted disease. However, few studies have clarified the clinical manifestations in these outbreaks involving the MSM population.
Beginning in June 2015, there was an outbreak of acute hepatitis A involving the MSM population in Northern Taiwan. We conducted a 15-year retrospective study by recruiting 207 patients with the diagnosis of acute hepatitis A that included the pre-outbreak (January 2001 to May 2015) and outbreak (June 2015 to August 2016) periods in a tertiary medical center in Northern Taiwan. Using risk factors, comorbidities, presenting symptoms, laboratory test results and imaging data, we aimed to evaluate the clinical significance of acute hepatitis A in the MSM population, where human immunodeficiency virus (HIV) coinfection is common.
There was a higher prevalence of reported MSM (p < 0.001), HIV (p < 0.001) and recent syphilis (p < 0.05) coinfection with acute hepatitis A during the outbreak period. The outbreak population had more prominent systemic symptoms, was more icteric with a higher total bilirubin level (p < 0.05) and had a 7-times higher tendency (p < 0.05) to have a hepatitis A relapse.
The clinical course of acute hepatitis A during an outbreak involving the MSM and HIV-positive population is more symptomatic and protracted than in the general population.
甲型急性肝炎是一种经粪-口传播的疾病，与卫生条件不佳有关。除了传统分类外，男男性行为者（MSM）群体中多次爆发甲型急性肝炎，使其被视为一种性传播疾病。然而，很少有研究阐明这些涉及MSM群体的疫情中的临床表现。
2015年6月起，台湾北部发生了一起涉及MSM群体的甲型急性肝炎疫情。我们在台湾北部的一家三级医疗中心进行了一项为期15年的回顾性研究，招募了207例诊断为甲型急性肝炎的患者，涵盖疫情前（2001年1月至2015年5月）和疫情期间（2015年6月至2016年8月）。利用风险因素、合并症、症状表现、实验室检查结果和影像学数据，我们旨在评估甲型急性肝炎在MSM群体中的临床意义，该群体中人类免疫缺陷病毒（HIV）合并感染较为常见。
疫情期间，报告的MSM合并甲型急性肝炎（p < 0.001）、HIV合并感染（p < 0.001）和近期梅毒合并感染（p < 0.05）的患病率更高。疫情群体有更明显的全身症状，黄疸更明显，总胆红素水平更高（p < 0.05），甲型肝炎复发的倾向高7倍（p < 0.05）。
在涉及MSM和HIV阳性人群的疫情中，甲型急性肝炎的临床病程比普通人群更有症状且病程更长。
