Co-Occurrence of Hepatitis A Infection and Chronic Liver Disease

Abstract

Hepatitis A virus (HAV) infection occasionally leads to a critical condition in patients with or without chronic liver diseases. Acute-on-chronic liver disease includes acute-on-chronic liver failure (ACLF) and non-ACLF. In this review, we searched the literature concerning the association between HAV infection and chronic liver diseases in PubMed. Chronic liver diseases, such as metabolic associated fatty liver disease and alcoholic liver disease, coinfection with other viruses, and host genetic factors may be associated with severe hepatitis A. It is important to understand these conditions and mechanisms. There may be no etiological correlation between liver failure and HAV infection, but there is an association between the level of chronic liver damage and the severity of acute-on-chronic liver disease. While the application of an HAV vaccination is important for preventing HAV infection, the development of antivirals against HAV may be important for preventing the development of ACLF with HAV infection as an acute insult. The latter is all the more urgent given that the lives of patients with HAV infection and a chronic liver disease of another etiology may be at immediate risk.

Keywords: GRP78; HBV; HCV; HIV; NASH; acute liver failure; nonalcoholic fatty liver diseases.

Figure 1

Effects of hepatitis A infection (HAV) on the prognosis of chronic liver disease. Possible acceleration and inhibition of the disease progression of hepatitis A are indicated by red and blue arrows, respectively. MAFLD, metabolic associated fatty liver disease; ALD, alcoholic liver disease; HIV, human immunodeficiency virus; HBV, hepatitis B virus; HCV, hepatitis C virus.

Figure 2

Possible molecular mechanism of the development of acute-on-chronic liver failure (ACLF) in patients coinfected with hepatitis A virus (HAV) and HCV. (a) Only HAV infection; (b) coinfection HAV and HCV. RIG-I, retinoic acid-inducible gene-I; MDA-5, melanoma differentiation associated gene 5; TLR3, toll-like receptor 3; MAVS, mitochondrial antiviral signaling protein; IRF3, interferon regulatory factor 3; IFN, interferon; ISG, interferon-stimulated gene; NF-κB, nuclear factor kappa B subunit 1.