Acute hepatitis E virus superinfection increases mortality in patients with cirrhosis

Abstract

Background Although acute hepatitis E is not fatal in healthy individuals, it is unclear whether hepatitis E superinfection increases the mortality in patients with pre-existing liver disease. Thus, we investigated the prognosis of patients with acute hepatitis E according to their cirrhosis diagnosis, and the prognosis according to the development of acute-on-chronic liver failure (ACLF) in patients with cirrhosis and chronic liver disease (CLD). Methods This study included 74 consecutive patients who were diagnosed with acute viral hepatitis E between January 2007 and December 2019. Of them, 39 patients without CLD, 13 patients with non-cirrhotic CLD, and 22 patients with cirrhotic CLD were analyzed. Results Among the 74 patients with HEV infection, 7 (9.5%) died within 180 days: 5 with underlying cirrhosis (71.4%) and 2 without cirrhosis (28.6%). The 180-day mortality was significant higher for patients with cirrhosis than for patients without cirrhosis (22.7% vs. 3.8%, P = 0.013). The age- and sex-adjusted proportional-hazard model revealed an approximately eightfold increase in the 180-day mortality risk in patients with cirrhosis compared to patients without cirrhosis. In addition, development of hepatitis E virus-related ACLF due to acute liver function deterioration in patients with pre-existing CLD or cirrhosis worsened the 180-day mortality rate. Conclusions Our findings suggest that the acute hepatitis E mortality rate was low in healthy individuals but higher in patients with cirrhosis, and especially high in those with ACLF.

Hepatitis E Virus Research in Brazil: Looking Back and Forwards

“…Patients with chronic liver disease have an increased risk of evolving into a more severe outcome, particularly to acute-on-chronic liver failure (ACLF), when superinfected with HEV [ 98 , 99 , 100 ]. In India, which is considered hyperendemic for HEV infection, Kumar Acharya et al (84) prospectively evaluated 107 patients with cirrhosis—most of them caused by viral hepatitis (HBV and HEV) and continuous alcohol consumption—and compared them with a control group.…”

Similarities, differences, and possible interactions between hepatitis E and hepatitis C viruses: Relevance for research and clinical practice

“…Coexistence of the two viruses appeared to be associated with accelerated progression of liver damage as evidenced by the reduced number of platelets, increased transaminases and prolonged prothrombin times observed in patients with chronic HCV hepatitis with HEV exposure during their lifetime (IgG-positive) when compared to HCV mono-infected patients[ 68 ]. It is possible that HEV infection in patients infected by HCV with a significant degree of liver fibrosis, accelerates liver damage to such an extent that liver decompensation and death may occur more frequently[ 69 ]. These considerations point to the importance of treating HCV and preventing HEV superinfection (either primary prevention or vaccine strategies) in patients affected by chronic HCV infection, a situation which may be particularly frequent or problematic in resource-limited settings.…”

Impact of prior HBV, HAV, and HEV infection on non‐alcoholic fatty liver disease

“…Nonetheless, both HAV and HEV are known to have the potential to cause severe liver injury, decompensation and increased mortality in patients with existing chronic liver disease. [14][15][16][17] The purpose of this study is to investigate the prevalence and association of previous HBV, HAV,…”