A long-term complex observation of 16 cynomolgus monkeys (Macaca fascicularis) and 8 African green monkeys (Cercopithecus aethiops) with spontaneous and experimental hepatitis A revealed two forms of the illness: acute and chronic. Some monkeys developed undulating chronic course of the disease consisting of 2-6 waves. Others developed relapses (1 to 3) which occurred within 2-4 or 6-11.5 months of the infection. The morphological changes in the liver persisted for 7-28 months. Alaninaminotransferase elevations in the blood and HAV shedding in feces were observed periodically for 7-20 months. HAV persistence was documented by radioimmunoassay, enzyme immunoassay, immune electron microscopy and molecular hybridization. Persisting HAV was shown to remain pathogenic for monkeys. Virological evidence of the etiological association of HAV with chronic infection and late relapses has been obtained for the first time.
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