Koga Michiko, Lim Lay Ahyoung, Ogishi Masato, Satoh Hidenori, Kikuchi Tadashi, Adachi Eisuke, Sugiyama Ryuichi, Kiyohara Tomoko, Suzuki Ryosuke, Muramatsu Masamichi, Koibuchi Tomohiko, Tsutsumi Takeya, Yotsuyanagi Hiroshi
Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo.
Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo.
Jpn J Infect Dis. 2020 Mar 24;73(2):89-95. doi: 10.7883/yoken.JJID.2019.275. Epub 2019 Oct 31.
Since 2017, hepatitis A virus (HAV) infection has been an epidemic among men who have sex with men (MSM) in Japan. We have come across 11 MSM patients with hepatitis A who were also infected with HIV. In 1999-2000, we came across 5 HIV-infected patients with hepatitis A. Since the conditions of current HIV-infected patients have changed owing to the recent progress in anti-HIV therapies, we compared clinical features of hepatitis A between patients in 2017-2018 and those in 1999-2000. By comparing the background characteristics of the patients, we found that the CD4/CD8 ratio was significantly higher in the 2017-2018 group. After the onset of hepatitis, peak levels of hepatic transaminases were found to be higher in the 2017-2018 group, suggesting severe hepatocellular damage. In contrast, neither the peak level of total bilirubin nor the nadir of prothrombin time was significantly different among the 2 groups. We also analyzed the HAV genome derived from some of the recently infected patients, and found that the HAV strains were almost the same among these patients; slight differences were observed from the previously identified strain. Thus, we concluded that the recovery of immunity by recent anti-HIV therapies may result in more severe hepatocellular damages and differences in clinical features.
自2017年以来，甲型肝炎病毒（HAV）感染在日本男男性行为者（MSM）中呈流行态势。我们遇到了11例同时感染HIV的甲型肝炎MSM患者。在1999 - 2000年，我们遇到了5例感染HIV的甲型肝炎患者。由于近期抗HIV治疗取得进展，当前HIV感染患者的病情已发生变化，我们比较了2017 - 2018年患者与1999 - 2000年患者甲型肝炎的临床特征。通过比较患者的背景特征，我们发现2017 - 2018年组的CD4/CD8比值显著更高。肝炎发病后，2017 - 2018年组的肝转氨酶峰值水平更高，提示肝细胞损伤严重。相比之下，两组间总胆红素峰值水平和凝血酶原时间最低点均无显著差异。我们还分析了部分近期感染患者的HAV基因组，发现这些患者的HAV毒株几乎相同；与先前鉴定的毒株存在细微差异。因此，我们得出结论，近期的抗HIV治疗使免疫力恢复可能导致更严重的肝细胞损伤及临床特征差异。
