Comparison of the Clinical Features of Hepatitis A in People Living with HIV between Pandemics in 1999–2000 and 2017–2018 in the 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 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.