Clinico-Pathological Spectrum of Hepatitis A Virus-Induced Autoimmune-Like Hepatitis in Children
Samannay Das
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorCorresponding Author
Vikrant Sood
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Correspondence:
Vikrant Sood ([email protected])
Search for more papers by this authorArchana Rastogi
Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorNeha Agarwal
Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorSanjeevani Kaul
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorDeepika Yadav
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorBikrant Bihari Lal
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorRajeev Khanna
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorSeema Alam
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorSamannay Das
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorCorresponding Author
Vikrant Sood
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Correspondence:
Vikrant Sood ([email protected])
Search for more papers by this authorArchana Rastogi
Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorNeha Agarwal
Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorSanjeevani Kaul
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorDeepika Yadav
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorBikrant Bihari Lal
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorRajeev Khanna
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorSeema Alam
Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Search for more papers by this authorFunding: The authors received no specific funding for this work.
ABSTRACT
There is limited evidence that hepatitis A virus (HAV) infection can trigger hepatic autoimmunity, but this area remains largely unexplored. This study was thus planned with the aim to compare HAV-induced autoimmune-like hepatitis (HAV-ALH) with HAV-related liver dysfunction (HAV-acute viral hepatitis or HAV-AVH) and classical autoimmune hepatitis (AIH). This was a retrospective review of 46 patients with HAV infection who underwent liver biopsy (including 17 cases of HAV-ALH: diagnosis based on histopathology), and they were compared to 46 cases of age- and gender-matched classical AIH. Overall, HAV cohort (n = 46) had higher prevalence of pruritus, higher bilirubin levels, higher proportion of cholestasis, lower IgG levels, higher seronegativity and lack of disease recurrence, while the classical AIH group had higher proportion/severity of interface hepatitis, fibrosis, necrosis and pseudorosetting (p < 0.05). In comparison to the classical HAV-AVH group, HAV-ALH group had higher AST levels, higher presence of autoantibodies, and higher prevalence of severe zone 3 perivenulitis and marked pseudorosetting on histology (p < 0.05). Also, HAV-ALH group, in comparison to the AIH group, had more pruritus (OR 7.29, p < 0.004) and more seronegativity (41% vs. 13%, p < 0.031), while duration of illness (p < 0.003), IgG (p < 0.001) levels and liver stiffness measurement (p < 0.006) were significantly higher in AIH group (versus the HAV-ALH and HAV-AVH groups). Histologically, in comparison to AIH, HAV-ALH group had significantly less interface hepatitis (OR 0.03, p < 0.001) and fibrosis (OR 0.08, p < 0.001) and significantly more cholestasis (OR 4.5, p < 0.021). HAV infection can act as a potential trigger for immune-mediated hepatic damage, akin to drug-induced autoimmune-like hepatitis. Larger multicentric studies are needed to further explore this aspect.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
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