title: Dynamics of HEV viremia, fecal shedding and its relationship with transaminases and antibody response in patients with sporadic acute hepatitis E.
abstract: BACKGROUND
  There is paucity of data regarding duration of fecal excretion and viremia on sequential samples from individual patients and its correlation with serum transaminases and antibody responses in patients with acute hepatitis E. This prospective study was undertaken at a tertiary care center in Northern India over 15 months. Only those patients of sporadic acute hepatitis E who were in their first week of illness and followed up weekly for liver function tests, IgM anti HEV antibody and HEV RNA in sera and stool were included. HEV RNA was done by RT - nPCR using two pairs of primers from RdRp region of ORF 1 of the HEV genome.
  
  
  RESULTS
  Over a period of 15 months 60 patients met the inclusion criterion and were enrolled for the final analysis. The mean age of the patients was 29.2 ± 8.92 years, there were 39 males. The positivity of IgM anti HEV was 80% at diagnosis and 18.3% at 7th week, HEV RNA 85% at diagnosis and 6.6% at 7th week and fecal RNA 70% at the time of diagnosis and 20% at 4th week. The maximum duration of viremia detected was 42 days and fecal viral shedding was 28 days after the onset of illness.
  
  
  CONCLUSIONS
  Present study reported HEV RNA positivity in sera after normalization of transaminases. Fecal shedding was not seen beyond normalization of transaminases. However, viremia lasted beyond normalization of transaminases suggesting that liver injury is independent of viral replication.
authors.affiliation: Department of Gastroenterology, SMS Medical College and Hospital, Jaipur (Rajasthan), India. neha.jagjit@gmail.com
authors.forename: Nidhi S
authors.initials: NS
authors.lastname: Chandra
authors.forename: Asha
authors.initials: A
authors.lastname: Sharma
authors.forename: Bharti
authors.initials: B
authors.lastname: Malhotra
authors.forename: Ramesh R
authors.initials: RR
authors.lastname: Rai
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005243:Feces / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D006508:Hepatitis Antibodies / Q000097:blood*; D016751:Hepatitis E / Q000276:immunology* / Q000821:virology*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007194:India; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D013223:Statistics as Topic; D000637:Transaminases / Q000097:blood*; D019562:Viral Load; D014766:Viremia; D017201:Virus Shedding; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D007075:Immunoglobulin M; D012367:RNA, Viral; D000637:Transaminases
references.citation: J Med Virol. 1995 Dec;47(4):303-8
references.pmid: 8636695
references.citation: Int J Gynaecol Obstet. 2001 Feb;72(2):103-8
references.pmid: 11166742
references.citation: Am J Gastroenterol. 2008 Oct;103(10):2495-501
references.pmid: 18785952
references.citation: Am J Med. 1981 Feb;70(2):252-5
references.pmid: 6781338
references.citation: J Clin Microbiol. 2000 Nov;38(11):3915-8
references.pmid: 11060044
references.citation: Lancet. 1993 Jan 16;341(8838):149-50
references.pmid: 8093748
references.citation: Gastroenterology. 1995 Jan;108(1):225-30
references.pmid: 7806046
references.citation: J Infect Dis. 1995 Oct;172(4):927-33
references.pmid: 7561211
references.citation: Anal Biochem. 1987 Apr;162(1):156-9
references.pmid: 2440339
references.citation: Science. 1990 Mar 16;247(4948):1335-9
references.pmid: 2107574
references.citation: Indian J Pathol Microbiol. 2000 Oct;43(4):433-6
references.pmid: 11344607
references.citation: J Med Virol. 1992 Aug;37(4):263-70
references.pmid: 1402825
references.citation: Lancet. 1993 Feb 6;341(8841):378
references.pmid: 8094150
references.citation: Hepatobiliary Pancreat Dis Int. 2007 Feb;6(1):38-42
references.pmid: 17287164
references.citation: J Med Virol. 2002 Jan;66(1):40-8
references.pmid: 11748657
references.citation: Lancet. 2000 Sep 23;356(9235):1081-2
references.pmid: 11009149