Hepatitis E virus in patients with decompensated chronic liver disease: a prospective <scp>UK</scp>/French study

Blasco-Perrin, Hélène; Madden, R.G.; Stanley, Adrian J.; Crossan, Claire; Hunter, Jeremy; Vine, Louisa; Lane, Katie; Devooght-Johnson, N.; McLaughlin, Cara; Petrík, Juraj; Stableforth, Bill; Hussaini, H.; Phillips, Mici; Mansuy, Jean‐Michel; Forrest, Ewan; Izopet, Jacques; Blatchford, Oliver; Scobie, Linda; Péron, Jean Marie; Dalton, Harry R.

doi:10.1111/apt.13309

Cited by 87 publications

(83 citation statements)

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“…A UK/French study also looked at the role of HEV infection in patients with decompensated chronic liver disease. 66 Acute HEV infection (genotype 3) was identified in a minority (3.2%) of patients with decompensated chronic liver disease, and there were no differences in mortality between patients with and without HEV infection.…”

Section: Clinical Featuresmentioning

confidence: 91%

“…65 Autochthonous (locally acquired) HEV infection is not a benign condition, with mortality rates up to 27% reported in patients with underlying chronic liver disease ( Figure 1). 66 Interesting geographical variations in genotype 3 HEV infection have been observed in France where there is considerable variation in seroprevalence by region from 8-86% 67 ; very high seroprevalence occurs in the southwest, southeast and northeast of the country. [66][67][68] The reason for this interesting observation is unclear, but contaminated foodstuffs in the food chain are likely to explain these geographical differences in part.…”

Section: Genotypementioning

confidence: 99%

“…66 Interesting geographical variations in genotype 3 HEV infection have been observed in France where there is considerable variation in seroprevalence by region from 8-86% 67 ; very high seroprevalence occurs in the southwest, southeast and northeast of the country. [66][67][68] The reason for this interesting observation is unclear, but contaminated foodstuffs in the food chain are likely to explain these geographical differences in part. There appears to be no correlation with potential transmission routes (eg, location of pig farms).…”

Section: Genotypementioning

confidence: 99%

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Review article: hepatitis E—a concise review of virology, epidemiology, clinical presentation and therapy

Donnelly

Scobie

Crossan

et al. 2017

Aliment Pharmacol Ther

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SummaryBackground: Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure.Aim: To detail current understanding of the molecular biology of HEV, diagnostic and therapeutic strategies and propose future directions for basic science and clinical research.Methods: PubMed was searched for English language articles using the key words "hepatitis E", "viral hepatitis", "autochthonous infection", "antiviral therapy", "liver transplantation", "acute", "chronic", "HEV", "genotype", "transmission" "food-borne", "transfusion". Additional relevant publications were identified from article reference lists. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.

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Section: Clinical Featuresmentioning

confidence: 91%

Section: Genotypementioning

confidence: 99%

Section: Genotypementioning

confidence: 99%

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Review article: hepatitis E—a concise review of virology, epidemiology, clinical presentation and therapy

Donnelly

Scobie

Crossan

et al. 2017

Aliment Pharmacol Ther

Self Cite

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“…One Indian study found that 28% of cirrhotic patients were HEV-RNA positive, with a 12-month mortality rate of 70% in this group versus 30% in non-infected individuals [31] . In developed countries, hepatitis E is an uncommon cause of decompensation, but varies by geographical location (1.1% in the UK; 7.9% in southwestern France [32] ). The mortality rate in these areas is not significantly different between patients with HEV-related decompensation and those with other causes (27 vs. 26%) [32] .…”

Section: Acute Infectionmentioning

confidence: 99%

“…In developed countries, hepatitis E is an uncommon cause of decompensation, but varies by geographical location (1.1% in the UK; 7.9% in southwestern France [32] ). The mortality rate in these areas is not significantly different between patients with HEV-related decompensation and those with other causes (27 vs. 26%) [32] . This possibly reflects differences in the pathogenicity of the dominant genotypes in different regions (HEV1 and HEV3 respectively) [33] .…”

Section: Acute Infectionmentioning

confidence: 99%

Hepatitis E Virus: Time to Change the Textbooks

Dalton

Webb

Norton

et al. 2016

Dig Dis

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Until recently, hepatitis E virus (HEV) was thought not to occur in developed countries. It is now clear that locally acquired HEV is common in such settings. HEV infection acquired in these areas differs from that in developing countries in a number of important aspects: it is caused by genotype 3 (and 4 in China and Japan), it mainly affects middle-aged/elderly males and it is zoonotic with a porcine primary host. Pig herds worldwide are infected with HEV genotype 3 and HEV has been found in the human food chain in a number of developed countries. However, the route of transmission is not fully understood, since most cases are not obviously associated with pigs/pig products. HEV can be transmitted by blood transfusion and surprisingly high numbers of asymptomatic blood donors are viremic at the time of donation: Germany 1:1,200, Netherlands 1:2,671, England 1:2,848. Our understanding of the clinical phenotype of HEV infection in humans has undergone a sea-change in recent years. Previously, HEV was thought to cause only acute self-limiting hepatitis. However, HEV may cause persistent disease in the immunocompromised. Patients with chronic HEV infection have no symptoms, but some develop rapidly progressive liver cirrhosis. The full clinical spectrum of HEV is still emerging. HEV has important extra-hepatic manifestations, which deserve further investigation. For example, HEV can cause a wide range of neurological illness. In particular, very recent data suggest that Guillain-Barré syndrome and neuralgic amyotrophy are associated with locally acquired HEV in approximately 5 and 10% of the cases, respectively.

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Retrospectively seroprevalence study on anti‐HEV‐IgG antibody in patients with chronic hepatitis or liver cirrhosis in a Chinese teaching hospital

Yang¹,

Wu²,

Yuan³

et al. 2018

Journal of Medical Virology

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Background and Objective To investigate the serum anti‐hepatitis E virus (HEV) antibody positive rate in patients with different types of chronic hepatitis (CH) or cirrhosis. Methods A total of 1751 hospitalized patients were chart reviewed, who were diagnosed with mono‐CH or cirrhosis between 2011 and 2016. Results The total anti‐HEV‐IgG positive rate was 1.33% (13/981) in CH patients, which was significantly lower than that (6.49%; 50/770) in cirrhosis patients (odds ratio [OR], 4.78 [2.51‐9.10]; P = 0.00). The comparison of positive rate of anti‐HEV‐IgG between the same etiology CH and cirrhosis groups was as follows: chronic hepatitis B 1.27% (10/790) versus hepatitis B virus (HBV)‐related cirrhosis 4.21% (22/522) (OR, 3.04 [1.36‐6.77]; P = 0.00); chronic alcoholic hepatitis 1.41% (1/71) versus alcoholic cirrhosis 9.40% (11/117) (OR, 8.00 [1.00‐64.25]; P = 0.03); chronic autoimmune hepatitis 1.69% (1/59) versus autoimmune cirrhosis 13.33% (12/90) (OR, 13.11 [1.49‐115.27]; P = 0.01); the differences above were statistically significant. And chronic hepatitis C 3.23% (1/31) versus hepatitis C virus‐related cirrhosis 10.81% (4/37) (OR, 4.40 [0.45‐43.53]; P > 0.05); chronic NASH 0.00% (0/30) versus NASH‐related cirrhosis 25.00% (1/4) (P > 0.05), the differences were not statistically significant. Anti‐HEV‐IgG positive rates were also compared among different types of CH groups and no significant difference was found. Likewise, anti‐HEV‐IgG positive rate was compared among different types of cirrhosis groups, showing that the positive rates of both alcoholic cirrhosis (9.40%) and autoimmune cirrhosis (13.33%) were significantly higher than that of HBV‐related cirrhosis (4.21%) (P < 0.05). Conclusion We observed that the cirrhosis patients had a significantly higher anti‐HEV‐IgG positive rate comparing with the CH patients, especially in those with HBV‐related, alcohol‐related, and autoimmune‐related cirrhosis (after adjusted for age). Additionally, it seems that the conditions of alcoholic cirrhosis and autoimmune cirrhosis are more susceptible to HEV infection due to the significantly higher positive anti‐HEV‐IgG rate in these patients.

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Hepatitis E virus in patients with decompensated chronic liver disease: a prospective UK/French study

Abstract: SUMMARY BackgroundIn developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genotype 3. In developing countries, hepatitis E is mainly caused by genotype 1, and causes increased mortality in patients with preexisting chronic liver disease (CLD).

Cited by 87 publications

References 50 publications

Review article: hepatitis E—a concise review of virology, epidemiology, clinical presentation and therapy

Review article: hepatitis E—a concise review of virology, epidemiology, clinical presentation and therapy

Hepatitis E Virus: Time to Change the Textbooks

Retrospectively seroprevalence study on anti‐HEV‐IgG antibody in patients with chronic hepatitis or liver cirrhosis in a Chinese teaching hospital

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