561 HEV IN RENAL TRANSPLANT AND HAEMODIALYSIS PATIENTS

Abstract

single center were enrolled consecutively. Anti-HAV IgM tests were repeated in patients with negative initial serology. Anti-HAV IgM antibodies were measured using commercially available enzyme linked fluorescent assay (VIDAS; BioMerieux, France). Results: Total 652 patients with symptomatic acute hepatitis had serology for HAV infection tested, and 620 patients were diagnosed as acute hepatitis A. Anti-HAV IgM was negative initially in 68 out of 620 patients diagnosed acute hepatitis A (11%). Hepatitis A patients whose initial serologic tests for HAV were negative had shorter time lapse from onset of symptoms to initial test (2.6±1.1 vs 5.9±2.6 days), higher rate of fever (98% vs 76%), higher ratio of AST/ALT (1.2±0.3 vs 0.8±0.4, p = 0.001), and lower level of bilirubin (1.6±1.1 vs 4.9±3.5mg/dL) compared with those with positive initial serologic tests for HAV. Among patients whose initial serologic tests for HAV were negative, patients diagnosed as acute hepatitis A showed significantly higher cut-off-index (COI) value of anti-HAV IgM than those diagnosed as non-A hepatitis. Conclusion: Anti-HAV IgM antibodies were negative in 11% of hepatitis A patients at initial presentation. Hepatitis A patients with negative initial serology showed the features of initial phase of illness. In the setting highly suggestive of acute hepatitis A, anti-HAV IgM tests should be repeated especially in patients with features of initial phase of hepatitis and high COI value of anti-HAV IgM considering window period of anti-HAV IgM antibody.