title: Host risk factors and autochthonous hepatitis E infection.
abstract: BACKGROUND
  In developed countries autochthonous hepatitis E infection is caused by hepatitis E virus (HEV) genotype 3 or 4 and mainly affects middle aged/elderly men. Host factors might explain why older men develop clinically overt disease.
  
  
  METHODS
  Retrospective review of 53 patients with symptomatic autochthonous hepatitis E infection to determine putative host risk factors. Patients were compared with 564 controls with adjustment for age and sex. Anti-HEV seroprevalence was determined in controls and 189 patients with chronic liver disease.
  
  
  RESULTS
  Mean age of the patients was 62.4 years, 73.6% were men. Compared with controls, patients with hepatitis E were more likely to drink at least 22 U alcohol/week (OR=9.4; 95% confidence interval=3.8-25.0; P<0.001). The seroprevalence of anti-HEV IgG in controls increased with age (P<0.001) but was similar in men and women. There was no association between alcohol consumption and anti-HEV IgG seroprevalence in the control group. There was no difference in the anti-HEV IgG seroprevalence between the controls and patients with chronic liver disease of all aetiologies, but seroprevalence was higher in controls (13.8%) than patients with alcoholic liver disease (4.8%, P=0.04).
  
  
  CONCLUSIONS
  Clinically apparent hepatitis E infection is more common in individuals who consume at least 22 U alcohol/week. Patients with established chronic alcoholic liver disease have a low seroprevalence compared with controls. The reason for this observation is uncertain, but patients with alcoholic liver disease have clinically severe disease with a high mortality when exposed to HEV. The low seroprevalence in this group may represent a 'culled' population.
authors.affiliation: European Centre for Environment & Human Health, Peninsula College of Medicine & Dentistry, Universities of Exeter and Plymouth, Truro, UK. harry.dalton@rcht.cornwall.nhs.uk
authors.forename: Harry R
authors.initials: HR
authors.lastname: Dalton
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bendall
authors.forename: Mo
authors.initials: M
authors.lastname: Rashid
authors.forename: Vic
authors.initials: V
authors.lastname: Ellis
authors.forename: Rachel
authors.initials: R
authors.lastname: Ali
authors.forename: Rene
authors.initials: R
authors.lastname: Ramnarace
authors.forename: William
authors.initials: W
authors.lastname: Stableforth
authors.forename: William
authors.initials: W
authors.lastname: Headdon
authors.forename: Rose
authors.initials: R
authors.lastname: Abbott
authors.forename: Cara
authors.initials: C
authors.lastname: McLaughlin
authors.forename: Emma
authors.initials: E
authors.lastname: Froment
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Hall
authors.forename: Nick P
authors.initials: NP
authors.lastname: Michell
authors.forename: Peter
authors.initials: P
authors.lastname: Thatcher
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D016751:Hepatitis E / Q000209:etiology*; D016752:Hepatitis E virus / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G