Prevalence and Impact of Hepatitis E Virus Infection Among Persons With Chronic Hepatitis B Living in the US and Canada

McGivern, David R.; Lin, Hsing Hua S.; Wang, Junyao; Benzine, Tiffany; Janssen, Harry L.A.; Khalili, Mandana; Lisker‐Melman, Mauricio; Fontana, Robert J.; Belle, Steven H.; Fried, Michael

doi:10.1093/ofid/ofz175

Cited by 8 publications

(14 citation statements)

References 37 publications

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“…Higher age also increases odds for HEV positivity in people with acute hepatitis (OR 2.04 (1.09–3.79) for those ≥ 60 years against <60 [ 63 ], and OR 1.5 (1.03–1.07) per-year increase) [ 64 ], and in those with immune deficiency (adjusted OR, 3.34 (1.54–7.24) for age ≥ 60 against <60 [ 65 ], and adjusted OR 1.05 (1.02–1.09) per 1 year increase) [ 66 ].…”

Section: Resultsmentioning

confidence: 99%

“…In the immunosuppressed group, being male was a risk factor for HEV (adjusted OR 2.07 (1.17–3.66)) [ 66 ], as well as for the viral hepatitis group (OR 2.10 (1.39–3.19)) [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

“…Among viral hepatitis patients, being born outside the United States or Canada (OR 2.09 (1.03–4.25)), or being Asian and less educated people living in Canada or in USA (OR 2.92 (1.42–6.01)) were also documented as a risk factor for HEV seropositivity [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

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Seroprevalence of hepatitis E virus infection in the Americas: Estimates from a systematic review and meta-analysis

et al. 2022

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Background Hepatitis E virus (HEV) infection is responsible for inflammatory liver disease and can cause severe health problems. Because the seroprevalence of HEV varies within different population groups and between regions of the continent, we conducted a systematic review on the topic in order to provide evidence for targeted prevention strategies. Methods We performed a systematic review in PubMed, SCIELO, LILACS, EBSCO, and Cochrane Library and included reports up to 25 May 2021 (PROSPERO registration number: CRD42020173934). We assessed the risk of bias, publication bias, and heterogeneity between studies and conducted a random-effect meta-analysis for proportions using a (binomial-normal) generalized linear mixed model (GLMM) fitted by Maximum Likelihood (ML). We also reported other characteristics like genotype and risk factors. Results Of 1212 identified records, 142 fulfilled the inclusion criteria and were included in the qualitative analysis and 132 in the quantitative analysis. Our random-effects GLMM pooled overall estimate for past infection (IgG) was 7.7% (95% CI 6.4%–9.2%) with high heterogeneity (I2 = 97%). We found higher seroprevalence in certain population groups, for example in people with pig related exposure for IgG (ranges from 6.2%–28% and pooled estimate of 13.8%, 95% CI: 7.6%–23.6%), or with diagnosed or suspected acute viral hepatitis for IgM (ranges from 0.3%–23.9% and pooled estimate of 5.5%, 95% CI: 2.0%–14.1%). Increasing age, contact with pigs and meat products, and low socioeconomic conditions are the main risk factors for HEV infection. Genotype 1 and 3 were documented across the region. Conclusion HEV seroprevalence estimates demonstrated high variability within the Americas. There are population groups with higher seroprevalence and reported risk factors for HEV infection that need to be prioritized for further research. Due to human transmission and zoonotic infections in the region, preventive strategies should include water sanitation, occupational health, and food safety.

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Section: Resultsmentioning

confidence: 99%

“…In the immunosuppressed group, being male was a risk factor for HEV (adjusted OR 2.07 (1.17–3.66)) [ 66 ], as well as for the viral hepatitis group (OR 2.10 (1.39–3.19)) [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

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Seroprevalence of hepatitis E virus infection in the Americas: Estimates from a systematic review and meta-analysis

et al. 2022

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“…Few studies have specifically evaluated HEV prevalence among U.S. adults with chronic HBV. One recent study of 600 random samples from the Hepatitis B Research Network Cohort Study observed 28.5% seroprevalence of HEV IgG 6 . Similarly, high prevalence of HEV antibodies have been reported in patients with chronic HCV 7 .…”

Section: Introductionmentioning

confidence: 90%

Prevalence of hepatitis E infection among adults with concurrent chronic liver disease

Wong

Cheung

Gish

et al. 2021

Journal of Viral Hepatitis

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While hepatitis E virus (HEV) infection can increase the risk of liver decompensation and death in patients with underlying chronic liver disease (CLD), prevalence of HEV in this cohort is not well reported. Using data from the 2011–2018 National Health and Nutrition Examination Survey, we aim to evaluate seroprevalence of HEV IgG among adults with non‐alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), chronic hepatitis C virus (HCV) and chronic hepatitis B virus (HBV). HEV IgG seroprevalence between groups was evaluated with chi‐square testing, and adjusted multivariate logistic regression models evaluated for predictors of seropositivity for HEV IgG. Seroprevalence of HEV IgG was 6.58% in ALD, 8.66% in HCV, 8.81% in NAFLD and 19.86% in HBV. We observed increasing HEV IgG seroprevalence over time in our study period, and in 2015–2018, seroprevalence was highest among the individuals with HCV (10.00%) and HBV (30.30%). Older age and being born outside of the United States were associated with seropositivity for HEV IgG in ALD, NAFLD, HBV, and for HCV, older age and being at or below poverty level were associated with seroprevalence for HEV IgG. In conclusion, we observed a relatively high prevalence of HEV among adults with CLD. These data highlight the need for greater awareness and education about the role of HEV in patients with underlying CLD, improving HEV test diagnostics, and revisiting the discussion about the potential role of HEV vaccines in CLD patients who are at higher risk of decompensation and death from acute HEV infection.

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“…8 Another study in Asian Americans in United States and Canada with Hepatitis B, found a high seroprevalence of anti-HEV IgG among the chronic HBV patients. 9 Although none of these studies adjusted for HIV status, there needs to be an urgent need for revaccination, for Hepatitis A and B, and enhanced hepatitis screening, for Hepatitis A-E, among HIV infected individuals.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional Assessment of HIV and Hepatitis A, B, C, D, and E among Individuals Surveyed in National Health and Nutrition Evaluation Survey, 1999–2018

Geyer

2021

MRAJ

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Objective: To assess the association with HIV with five strains of viral hepatitis, in adults 18-59 years, who have taken the NHANES survey for HIV, and to determine if there is a positive association with HIV in each of the five viral hepatitis strains adjusted by age, gender, and race. Methods: Cross-sectional analysis of HIV Screening Test by Laboratory test results for Hepatitis A, B, C, D, and E screenings, using 10 pooled datasets from the 1999-2018 biennial National Health and Nutritional Examination Surveys. Statistical analyses performed included Spearman’s Correlations, weighted Rao-Scott Chi-Square tests, and weighted binary logistic regression modeling. Results: In the subset of 33,214 adult participants surveyed in the 1999-2018 NHANES the percentage of HIV positivity was 0.44% (standard error=0.05), with 56% occurring in 2009-2018. Weighted Rao-Scott Chi-Square Tests had a statistically significant association between HIV and the five hepatitis strains, with four having a p-value <=0.0001, except for Hepatitis D. After adjustment by age, race, and gender HIV was positively associated odds ratios. Hepatitis A had a statistically significant odds ratio for 1999-2018 but was not significant for 1999-2006 and 2007-2018. Hepatitis B and Hepatitis C had a statistically significant association in all three subsets. Hepatitis D had no HIV coinfection in 1999-2006, so it was not reported, and a nonsignificant association in 2009-2018. Hepatitis E, which started collection in 2009, had a nonsignificant association with HIV in 2009-2018. Conclusion: Based on this analysis and the review of HIV and viral hepatitis guidelines it is suggested that immunocompromised individuals, including HIV positives, should be screened for all five strains of viral Hepatitis. Further research is needed in order to better understand the connection between HIV and viral hepatitis strains, especially Hepatitis A, Hepatitis D, or Hepatitis E.

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Prevalence and Impact of Hepatitis E Virus Infection Among Persons With Chronic Hepatitis B Living in the US and Canada

Cited by 8 publications

References 37 publications

Seroprevalence of hepatitis E virus infection in the Americas: Estimates from a systematic review and meta-analysis

Seroprevalence of hepatitis E virus infection in the Americas: Estimates from a systematic review and meta-analysis

Prevalence of hepatitis E infection among adults with concurrent chronic liver disease

Cross-sectional Assessment of HIV and Hepatitis A, B, C, D, and E among Individuals Surveyed in National Health and Nutrition Evaluation Survey, 1999–2018

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