Hepatitis E Virus Superinfection and Clinical Progression in Hepatitis B Patients

Abstract

Hepatitis E virus (HEV) infection may cause acute hepatitis and lead to hepatic failure in developing and developed countries. We studied HEV seroprevalences in patients with hepatitis B virus (HBV) infection to understand the consequences of HEV superinfection in a Vietnamese population. This cross-sectional study was conducted from 2012 to 2013 and included 1318 Vietnamese patients with HBV-related liver diseases and 340 healthy controls. The case group included patients with acute (n = 26) and chronic hepatitis B (n = 744), liver cirrhosis (n = 160), hepatocellular carcinoma (n = 166) and patients with both liver cirrhosis and hepatocellular carcinoma (n = 222). Anti-HEV IgG and IgM antibodies were assessed in patients and controls by ELISA. HEV-RNA was identified by PCR assays and sequencing. Seroprevalences of anti-HEV IgG among hepatitis B patients and controls were 45% and 31%, respectively (adjusted P = 0.034). Anti-HEV IgM seroprevalences were 11.6% and 4.7% in patients and controls, respectively (adjusted P = 0.005). Seroprevalences were higher among the elder individuals. When stratifying for patient groups, those with liver cirrhosis had the highest anti-HEV IgG (52%) and anti-HEV IgM (19%) seroprevalences. Hepatitis B patients with current HEV infection had abnormal liver function tests compared to patients with past or without HEV infection. One HEV isolate was retrieved from a patient with both liver cirrhosis and hepatocellular carcinoma and identified as HEV genotype 3. This study indicates high prevalences of HEV infection in Vietnamese HBV patients and among healthy individuals and shows that HEV superinfection may influence the outcome and progression of HBV-related liver disease.

Clinical features of acute hepatitis E super-infections on chronic hepatitis B

“…On one hand, the underlying CHB could predispose the co-infected patients to more severe symptoms than HEV mono-infections[10,11]. On the other hand, HEV infection may also aggravate the clinical outcome of HBV infection, especially under conditions of liver cirrhosis[26]. Notably, HEV super-infections were reported as the second most prevalent precipitating factor in triggering ACLF in CHB patients[27,28], revealing a mutual influence among the viral co-infections.…”

Prevalence and genotype distribution of hepatitis delta virus among chronic hepatitis B carriers in Central Vietnam

“…Vietnam is a South-East Asian country with a high prevalence of HBV infection and approximately 10–20% of general populations live with chronic hepatitis B [29, 30]. High prevalence of HDV is reported in HBsAg positive patients in Northern provinces of Vietnam, especially in patients with acute hepatitis B with up to 43% [31].…”

Where Hepatitis B and Hepatitis E Meet: Epidemiological and Clinical Aspects

“…38% has been reported in previous studies in China (34)(35)(36)(37)(38). In Southeast Asia, the HBV-HEV superinfection rate was reported to be 45%, 14% and 9.5% in Vietnam, India and Bangladesh, respectively (39)(40)(41). A clear territory-wise distribution of HBV-HEV superinfection has been observed in Africa where a higher prevalence of 56.7% was reported in Egypt in the northern part of the continent, while insignificant rates of 1% and 0% were reported in Kenya, the Eastern part of Africa (27,42,43) (Table 1).…”

“…Other features such as accelerated rates of liver injury, a progression of HBV-related CLD to more severe forms and rapid decompensation to liver failure have also correlated with HEV superinfection in CHB patients. In a recent large Vietnamese survey by Hoan et al (39), HEV seropositivity was found to be associated with the presence of liver cirrhosis and HCC among CHB patients. The poor prognosis of cirrhotic patients based on the Child-Pugh score also correlated with HEV superinfection in this study.…”