Hepatitis E virus infection and acute‐on‐chronic liver failure in West Africa: a case–control study from The Gambia

Abstract

Summary Background In sub‐Saharan Africa, it is unknown whether hepatitis E virus (HEV) infection is a common precipitating event of acute‐on‐chronic liver failure (ACLF). Aims To estimate the prevalence of HEV infection in general population and assess whether HEV is a common trigger of ACLF in cirrhotic patients in The Gambia, West Africa. Methods We first conducted an HEV sero‐survey in healthy volunteers. We then tested cirrhotic patients with ACLF (cases) and compensated cirrhosis (controls) for anti‐HEV IgG as a marker of exposure to HEV, and anti‐HEV IgA and HEV RNA as a marker of recent infection. We also described the characteristics and survival of the ACLF cases and controls. Results In the healthy volunteers (n = 204), 13.7% (95% CI: 9.6–19.2) were positive for anti‐HEV IgG, and none had positive HEV viraemia. After adjusting for age and sex, the following were associated with positive anti‐HEV IgG: being a Christian, a farmer, drinking water from wells, handling pigs and eating pork. In 40 cases (median age: 45 years, 72.5% male) and 71 controls (39 years, 74.6% male), ≥70% were infected with hepatitis B virus. Although hepatitis B flare and sepsis were important precipitating events of ACLF, none had marker of acute HEV. ACLF cases had high (70.0%) 28‐day mortality. Conclusions Hepatitis E virus infection is endemic in The Gambia, where both faecal‐oral route (contaminated water) and zoonotic transmission (pigs/pork meat) may be important. However, acute HEV was not a common cause of acute‐on‐chronic liver failure in The Gambia.

Systematic review with meta‐analysis: the association between hepatitis E seroprevalence and haemodialysis

“…Hepatitis E virus infection can be a serious disease, with manifestations ranging from acute liver failure, to acute‐on‐chronic liver failure or chronic hepatitis in immunosuppressed patients . Moreover, it may not be readily recognised at times, as it may masquerade as drug‐induced liver injury or as myriad of extrahepatic manifestations, such as neurological manifestations, acute pancreatitis, cryoglobulinemic disease, acute liver failure and chronic renal disease .…”

The Clinical Perspective on Hepatitis E

“…However, mortality in HEV-ACLF was lower at 18% compared to other ACLF etiologies [53,54]. In contrast, in West Africa acute HEV infection was not observed as a common cause of ACLF [55].…”

Battlefield against hepatitis B infection and HCC in Africa

“…In patients with acute-onchronic liver failure, a case-controlled study nested in the PROLIFICA programme found a high cumulative mortality rate at 28-and 90-day (70.0% and 92.9% respectively). Moreover, the vast majority of the patients were young men (median age 45 years ) [7]. In Europe, the median age at presentation with HCC is 65 years [8]; in contrast the median Journal of Hepatology 2017 vol.…”