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HEV not linked to acute-on-chronic liver failure in West Africa

Researchers found hepatitis E virus infection to be prevalent in The Gambia, West Africa.  However, it was not an indication for acute-on-chronic liver failure, according to study data.

“Hepatitis E epidemics have been reported in several African countries, and between 5% and 70% of sporadic cases of acute hepatitis present with laboratory evidence of acute HEV infection,” Yusuke Shimakawa, MD, Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France, and colleagues wrote. “However, whether acute hepatitis E is a common trigger of acute decompensation of cirrhosis has never been investigated in [sub-Saharan Africa], where both chronic liver disease and HEV infection are common.”

To estimate how common HEV is, the researchers conducted a cross-sectional sero-survey of 204 healthy participants between April and September 2012. The overall prevalence of anti-HEV immunoglobulin G (IgG) was 13.7% (n = 28). None of these patients were positive for HEV viremia. Further analyses, after adjusting for age and sex, showed that being Christian, a farmer, drinking water from wells, interacting with pigs and eating pork were all associated with positive anti-HEV IgG.

Researchers then analyzed data of 40 patients with acute-on-chronic liver failure (ACLF) and 71 control patients with cirrhosis in a case-control study, to determine if anti-HEV IgG was a marker of exposure to HEV and if anti-HEV IgG and HEV RNA are markers of recent infection, according to the research.

Of these patients, 70% of the cases of ACLF and 77.5% of controls showed evidence of hepatitis B virus. The prevalence of anti-HEV IgG was not significantly different between the groups (P = .2). None of the patients had anti-HEV IgG or HEV RNA. In the cases with ACLF, more showed evidence of HBV flare and sepsis. Further analysis, adjusting for age and sex, showed HBV flare (OR = 10.8; 95% CI, 1.2-98.2) and sepsis (OR = 6.7; 95% CI, 1.7-26.9) to be associated with ACLF.

The researchers concluded: “Despite a high prevalence of anti-HEV in the general population in The Gambia, we did not find any case of ACLF precipitated by acute HEV infection. … As acute hepatitis E is likely to become a potentially vaccine preventable disease, its incidence and related mortality in other high-risk groups, such as pregnant women, as well as in the general population, deserve to be elucidated in The Gambia and other African countries.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.