Jpn.J.Infect.Dis., 52, 1999

Laboratory and Epidemiology Communications

Outbreak of Hepatitis A Virus Infection among HIV-1 Seropositive Men Who Had Sex with Men

Tateru Ishida1, Tetsuya Nakamura2, Atsushi Ajisawa3, Masayoshi Negishi3, Tetsuya Kashiyama4, Akiko Takechi4 and Aikichi Iwamoto1,2,*

1Department of Infectious Diseases, 2Department of Infectious Disease and Applied Immunology, Institute of Medical Science, University of Tokyo, Shirokanedai 4-6-1, Minato-ku, Tokyo, 3Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Honkomagome 3-18-22, Bunkyo-ku, Tokyo, and 4Department of Internal Medicine, Tokyo Metropolitan Ohkubo Hospital, Kabukicho 2-44-1, Shinjuku-ku, Tokyo

Communicated by Aikichi Iwamoto

(Accepted July 5, 1999)

Hepatitis A virus (HAV) is transmitted fecal-orally. In Japan, most outbreaks occur between January and May. The number of reported HAV cases is decreasing in Japan probably due to improved hygiene (solid circles in Fig. 1).

We encountered an outbreak of HAV infection involving thirteen HIV-1 infected men who had had sex with men (MSM). Eleven cases had been treated for HIV infection at the outpatient clinics of three hospitals in Tokyo. Two cases were found positive for anti-HIV-1 antibody when the diagnosis of HAV infection was made. The outbreak started in July 1998, peaking in January-March of 1999 (bars in Fig. 1). In the period between July 1998 and April 1999 when the last data was collected, about 550 HIV-1 positive patients were treated at the three hospitals, meaning that 2.3 % of the HIV-1-infected patients (13 in 550 including both MSM and non-MSM) were infected with HAV. As hepatitis A has been decreasing in the last 10 years (solid circles in Fig. 1), this outbreak was unexpected.

All the 13 patients had had sex with men. Twelve (92 %) tested seropositive for syphilis and five experienced amebiasis. Though all the patients were negative for hepatitis C virus antibody, three patients were positive for hepatitis B virus surface antigen. Their CD4+ cell counts were 463±153 at the diagnosis of hepatitis A. Eight patients were receiving highly active anti-retroviral therapy (HAART) (Table 1).

Their clinical symptoms were week-long fever (above 38℃), malaise, anorexia, diarrhea, and cola-colored urine. All the patients had elevated levels of anti-HAV IgM (cutoff index: 6.5±0.9). The peak value for aspartate aminotransferase was 1152±720, that for alanine aminotransferase 2070±812, and that for total bilirubin 5.5±2.8. All
the patients recovered from HAV infection in a month. Three patients among eight who had been treated with HAART, however, had to be withheld temporarily from the therapy due to HAV infection.

The ages of those attaining 50 % HAV-seropositive status is becoming higher in the Japanese population. In 1973 it was individuals in their 20's, in 1984, those in their 30's, and those in their 40's in 1994(1). The younger population is at increasing risk of HAV infection. Vaccination against HAV has been recommended for MSM(2). It may particularly apply to HIV-1-infected MSM so as not to compromise HAART.

REFERENCES

  1. Kiyohara, T., Satoh, T., Yamamoto, H., Totsuka, A. and Moritsugu, Y. (1997): The latest seroepidemiological pattern of hepatitis A in Japan. Jpn. J. Med. Sci. Biol., 50, 123-131.
  2. From the CDC (1992): Hepatitis A among homosexual men-United States, Canada, and Australia. JAMA., 267, 1587-1588.

*Corresponding Author : Fax: 81-3-5449-5427, E-mail: aikichi＠ims.u-tokyo.ac.jp

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