Does high viral load of hepatitis E virus influence the severity and prognosis of acute liver failure during pregnancy?

Abstract

The incidence and mortality in pregnant women with acute liver failure caused by hepatitis E virus (HEV) is high. Data on the viral load of HEV during pregnancy are limited. The study was designed to determine the viral load of HEV and its association with the disease severity in patients with acute liver failure. A total of HEV related 163 patients with acute liver failure which included 105 pregnant, 46 non-pregnant women and girls and 12 men and 730 patients with acute viral hepatitis which comprised of 220 pregnant women; 282 non-pregnant women and girls and 228 men were included. Viral load was measured by real-time PCR. Comparison was made between the pregnant and non-pregnant women. HEV RNA was detectable in 265 patients (142 pregnant; 75 non-pregnant and 48 men) and 104 patients with acute liver failure (64 pregnant, 34 non-pregnant and 6 men). The viral load of HEV in pregnant women with acute liver failure and acute viral hepatitis was significantly higher 129,984.0 ± 103,104.17 and 768.92 ± 1,105.40 copies/ml, respectively compared to the non-pregnant women which was 189.2 ± 225 and 12.73 ± 7.8 copies/ml (P < 0.0001). The viral load of HEV was also significantly higher in the pregnant patients with acute liver failure compared to the pregnant women with acute viral hepatitis and also men (P < 0.0001). High viral load of HEV during pregnancy could be one of the factors responsible for the severity of the infection during pregnancy.

Hepatitis E virus replication and interferon responses in human placental cells

“…Nevertheless, these cases do not indicate a comparable severe outcome of gt3 infections during pregnancy. Of note, high viral loads of HEV during pregnancy have been implicated as one of the factors responsible for the severity of the infection during pregnancy 48, 49. JEG‐3 cells allowed HEV viral particle production with membrane‐associated extracellular viral particles and biophysical properties comparable to human liver cell‐derived viruses (Fig.…”

Hepatitis E and Acute Liver Failure in Pregnancy

“…A study from North India reported a correlation of viral load with increased severity of infection during pregnancy. 75 In this study, the HEV viral load in ALF pregnant women was 5.87 Â 10 4 AE 1.5 Â 10 5 mL/mL as compared to AVH pregnant women 343.29 AE 216.44 mL/mL. The viral load in ALF and AVH in non-pregnant women was 199.2 AE 225.5 mL/mL and 13.83 AE 7.8 mL/mL, respectively.…”

Liver Failure in Pregnancy

“…However, pregnant women with acute HEV infection are at risk for fulminant hepatitis, liver failure, and high maternal mortality and morbidity rates. 7,29 In an attempt to identify causes associated with this high mortality rate of HEV, Borkakoti and colleagues 29 found that the viral loads of HEV in pregnant women with ALF were significantly higher than those in nonpregnant women.…”