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Prevalence of Hepatitis C Virus Infection in Patients Hospitalized for Hepatitis A

TO THE EDITOR: Preexisting chronic liver disease and associated hepatitis C virus (HCV) infection were suggested as factors that aggravate hepatitis A (1, 2). However, the prevalence of HCV infection in patients with serious hepatitis A is unknown. We therefore looked for HCV infection in such patients. From January 1990 to February 1998, 59 patients with hepatitis A were hospitalized at our center. On admission, 78% had severe coagulopathy (prothrombin ratio<50%) and 49% had marked jaundice (serum bilirubin level>170 mol/L [9.9 mg/dL]). No patient had detectable anti-HCV antibodies or detectable serum HCV RNA. Of these patients, 14% had fulminant hepatitis and 7% died. Although our series included patients with more serious illness than did the series of 256 U.S. patients in the study by Willner and colleagues (3), no patient had HCV infection. Assuming that HCV infection increases the risk for fulminant hepatitis A implies two mandatory consequences: an increased incidence of fulminant hepatitis A in patients with HCV infection and an increased prevalence of HCV infection in patients with severe, fulminant hepatitis A. Vento and associates (2) found an increased incidence of fulminant hepatitis A in patients with HCV infection (41% [7 of 17 patients]), but others have not confirmed this finding (4). In addition, no increased prevalence of HCV infection was found in 1768 Italian patients with hepatitis A (5). Thus, neither the increased incidence of fulminant hepatitis A in patients with HCV infection nor the increased prevalence of HCV infection in patients with severe and fulminant hepatitis A is firmly established. In conclusion, the assumption of a promoting influence of HCV infection on the development of severe forms of hepatitis A remains undemonstrated. Our data do not support the recent recommendation to extend the vaccination against hepatitis A virus to all patients with HCV infection (2).