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Comparison of clinical features of hepatitis A in people living with HIV between pandemic in 1999-2000 and that in 2017-2018 in a metropolitan area of Japan.

Since 2017, hepatitis A virus (HAV) infection has been an epidemic among men who have sex with men (MSM) in Japan. We experienced 11 MSM patients with hepatitis A who were also infected with HIV. In 1999-2000, we also experienced 5 HIV-infected patients with hepatitis A. Since conditions of current HIV-infected patients have changed owing to 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 patients' background characteristics, we found the CD4/CD8 ratio was significantly higher in the 2017-2018 group. After the onset of hepatitis, peak levels of hepatic transaminases were higher in the 2017-2018 group, suggesting the hepatocellular damage was more severe. On the other hand, neither the peak level of total bilirubin nor the nadir of prothrombin time was significantly different. We also analyzed the HAV genome derived from some of the recently infected patients and found the HAV strains were almost the same among these patients and slightly different from a previously identified strain. The recovery of immunity by recent anti-HIV therapies may result in a more severe hepatocellular damages and differences in clinical features.