Background Patients with chronic hepatitis B virus (HBV) may experience spontaneous biochemical flares of liver disease activity. This study aimed to determine (i) the prevalence of prior and possible acute hepatitis E virus (HEV) infection among persons with chronic HBV and (ii) whether HEV infection is associated with liver disease flares among persons with chronic HBV. Methods Serum from a random sample of 600 adults in the Hepatitis B Research Network Cohort Study was tested for HEV RNA and anti-HEV IgM and IgG. Logistic regression models were used to estimate crude and adjusted odds ratios of anti-HEV prevalence for participant characteristics. Results Anti-HEV IgG and IgM seroprevalence was 28.5% and 1.7%, respectively. No participants had detectable HEV RNA. Of the 10 anti-HEV IgM+ participants, only 1 had elevated serum ALT at seroconversion. The odds of anti-HEV seropositivity (IgG+ or IgM+) were higher in older participants, males, Asians, less educated people, and those born outside the United States and Canada. Conclusions Acute HEV infection is a rare cause of serum ALT flares among persons with chronic HBV. The high seroprevalence of anti-HEV IgG among the chronic HBV patients is strongly associated with various demographic factors in this largely Asian American cohort.

Objectives To determine if selected socio-demographic and HBV-specific clinical factors are associated with health-related quality of life (HRQoL) among pediatric patients chronically infected with hepatitis B virus (HBV). Methods Children with chronic HBV enrolled in the Hepatitis B Research Network completed the Child Health Questionnaire (CHQ) at study entry. Caregivers of children 5–<10 years completed the parent-reported PF50; youth 10–< 18 years completed the child-reported CF87. We examined univariable associations of CHQ scores with selected independent variables: sex, adoption status, maternal education, alanine aminotransferase (ALT, U/L), aspartate aminotransferase-to-platelet ratio index (APRI), and HBV-specific symptom count. Results 244 participants (83 young children 5–<10y, 161 youth 10–<18y) were included, all HBV treatment naïve. Among young children, increased ALT level was negatively associated with PF50 psychosocial summary T-Score (r=−0.28, p=0.01). No other subscale comparisons for young children were statistically significant. Among youth, adoption was associated with better physical functioning and general health (p<0.01). Higher maternal education was associated with better role/functioning-physical and -emotional scores (p<0.05). Maternal education and adoption status were linked, with adoption associated with higher maternal education. Increased symptom count in youth was associated with worse HRQoL in subscales measuring bodily pain, behavior, mental health, and self-esteem (p<0.01). Conclusions Although overall HRQoL is preserved in children with chronic HBV, some socio-demographic and HBV-related clinical factors were associated with impaired HRQoL in our pediatric patients at baseline. Measurement of HRQoL can focus resources on education and psychosocial support in children and families most in need.