Optimal time for repeating the IgM anti-hepatitis A virus antibody test in acute hepatitis A patients with a negative initial test

• Published in: Clinical and molecular hepatology 2012, 18(1), , pp.56-82
• Main Authors: Hyun, Jong Jin, Seo, Yeon Seok, An, Hyonggin, Yim, Sun Young, Seo, Min Ho, Kim, Hye Sook, Kim, Chang Ha, Kim, Ji Hoon, Keum, Bora, Kim, Yong Sik, Yim, Hyung Joon, Lee, Hong Sik, Um, Soon Ho, Kim, Chang Duck, Ryu, Ho Sang
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Alanine Transaminase - blood; Female; Hepatitis A; Hepatitis A - diagnosis; Hepatitis A Antibodies - blood; Hepatitis A virus - immunology; Hospitalization; Humans; Immunoglobulin M - blood; Male; Medical records; Odds Ratio; Original; Regression analysis; Retrospective Studies; Time Factors; 내과학
• ISSN: 1738-222X; 2287-2728; 2093-8047; 2287-285X
• DOI: 10.3350/kjhep.2012.18.1.56

The nonspecific clinical presentation of acute hepatitis A (AHA) mandates the detection of anti-hepatitis A virus IgM antibodies (IgM anti-HAV) in the serum for obtaining a definitive diagnosis. However, IgM anti-HAV might not be present during the early phase of the disease. The aim of this study was to determine the optimal time for repeating the IgM anti-HAV test (HAV test) in AHA patients with a negative initial test. In total, 261 patients hospitalized with AHA were enrolled for this retrospective study. AHA was diagnosed when the test for IgM anti-HAV was positive and the serum alanine aminotransferase (ALT) level was ≥400 IU/L. Repeat HAV test was conducted after 1-2 weeks if the initial HAV test was negative but AHA was still clinically suspected. The results of the initial HAV test were negative in 28 (10.7%) patients. The intervals from symptom onset to the initial-HAV-test day and from the peak-ALT day to the initial-HAV-test day were significantly shorter in the negative-initial-HAV-test group, but on multivariate analysis only the latter was significantly associated with negative results for the initial HAV test (β=-0.978; odds ratio [95% confidence interval]=0.376 [0.189-0.747]; P=0.005). The HAV test was positive in all patients when it was performed at least 2 days after the peak-ALT day. The results of HAV tests were significantly associated with the interval from the peak-ALT day to the HAV-test day. The optimal time for repeating the HAV test in clinically suspicious AHA patients with a negative initial HAV test appears to be at least 2 days after the peak-ALT day.