High Incidence of Acute Liver Failure among Patients in Egypt Coinfected with Hepatitis A and Hepatitis E Viruses

Abstract

Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are transmitted through the fecal–oral route. HAV outbreaks and one HEV outbreak have been reported in Egypt. However, the impact of HAV–HEV co-infection is not known. In this study, we assessed HEV markers in acute HAV-infected patients (n = 57) enrolled in Assiut University hospitals. We found that 36.8% of HAV-infected patients were also positive for HEV markers (anti-HEV IgM and HEV RNA), while 63.2% of the patients were HAV mono-infected. Demographic and clinical criteria were comparable in both HAV mono-infected patients and HAV–HEV co-infected patients. Although liver enzymes were not significantly different between the two groups, liver transaminases were higher in the co-infected patients. Six patients developed acute liver failure (ALF); five of them were HAV–HEV-co-infected patients. The relative risk of ALF development was 8.5 times higher in HAV–HEV co-infection compared to mono-infection. Three cases of ALF caused by HAV–HEV co-infection were reported in children (below 18 years) and two cases were reported in adults. All patients developed jaundice, coagulopathy, and encephalopathy; all were living in rural communities. In conclusion: HAV–HEV co-infection can be complicated by ALF. The risk of ALF development in HAV-infected patients is higher when coinfection with HEV is present.

Recent advances in hepatitis E virus research and the Japanese clinical practice guidelines for hepatitis E virus infection

“…Host factors Older age 163,171 Genetic factors 192,194 Viral factors HEV viral load 174,195 HEV genotype 163,164,195 Nucleotide mutation 172,208 Other factors Existence of chronic liver disease 229,232 Existence of metabolic disease 242,250 Coinfection of HAV 244 Abbreviations: HAV, hepatitis A virus; HEV, hepatitis E virus. women and 41-year-old men) contracted HEV infection through blood transfusion.…”

“…136 Recently, El-Mokhtar et al reported that the risk of ALF development was 8.5fold greater in patients coinfected with HAV and HEV than in those with monoinfection. 244 For HEV-ALF patients younger than 65 years, 21 liver transplantation should be considered a therapeutic option.…”

Emerging Pathogens Causing Acute Hepatitis

“…The liver function profile was comparable in the HAV-HEV coinfected patients and HAV mono-infected ones. However, the risk of acute liver failure was higher among the coinfected patients [37].…”

“…However, the outcomes of this co-infection are not known. In this issue, EL-Mokhtar and colleagues reported that 36.8% of HAV-infected patients were HAV-HEVcoinfected ones [37]. The liver function profile was comparable in the HAV-HEV coinfected patients and HAV mono-infected ones.…”