title: Influence of chronic HBV infection on superimposed acute hepatitis E.
abstract: OBJECTIVE
  To investigate the influence of chronic hepatitis B virus (HBV) infection [based on the status of hepatitis B e antigen (HBeAg), HBV DNA, and cirrhosis] on superimposed acute hepatitis E.
  
  
  METHODS
  A total of 294 patients were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University, from January 2003 to January 2012. The patients were classified into two groups: an HBV + hepatitis E virus (HEV) group (a group with chronic HBV infection that was superinfected with acute hepatitis E, n = 118) and an HEV group (a group with acute hepatitis E, n = 176). We retrospectively analyzed and compared the clinical features of the two groups. Statistical analyses were performed using the χ(2) test or Fisher's exact test for categorical variables and the Student's t test for continuous variables. A P value < 0.05 was considered statistically significant.
  
  
  RESULTS
  The peak values of prothrombin time, serum total bilirubin, and Model for End-Stage Liver Disease scores were significantly higher in the HBV + HEV group. More patients in the HBV + HEV group had complications (39.8% vs 16.5%, P = 0.000) and developed liver failure (35.6% vs 8.5%, P = 0.000). Additionally, the mortality of the HBV + HEV group was significantly higher (20.3% vs 7.4%, P = 0.002). Further analysis of the HBV + HEV group showed that there were no significant differences in complication occurrence, liver failure incidence, or mortality between patients with different HBeAg and HBV DNA statuses. However, in patients with underlying cirrhosis, complication occurrence and liver failure incidence significantly increased. In total, 12.7% of the patients in the HBV + HEV group received anti-HBV treatment, but this therapy failed to reduce mortality in patients who developed liver failure.
  
  
  CONCLUSIONS
  The presence of underlying cirrhosis in chronic HBV infection results in more severe clinical outcomes with superimposed acute hepatitis E. Anti-HBV treatment cannot improve the prognosis of liver failure caused by HBV-HEV superinfection.
authors.affiliation: Si-Hong Cheng, Li Mai, Feng-Qin Zhu, Xing-Fei Pan, Hai-Xia Sun, Hong Cao, Xin Shu, Wei-Min Ke, Gang Li, Qi-Huan Xu, Department of Infectious Diseases, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
authors.forename: Si-Hong
authors.initials: SH
authors.lastname: Cheng
authors.forename: Li
authors.initials: L
authors.lastname: Mai
authors.forename: Feng-Qin
authors.initials: FQ
authors.lastname: Zhu
authors.forename: Xing-Fei
authors.initials: XF
authors.lastname: Pan
authors.forename: Hai-Xia
authors.initials: HX
authors.lastname: Sun
authors.forename: Hong
authors.initials: H
authors.lastname: Cao
authors.forename: Xin
authors.initials: X
authors.lastname: Shu
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Ke
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.forename: Qi-Huan
authors.initials: QH
authors.lastname: Xu
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D060085:Coinfection; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D016751:Hepatitis E / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000821:virology; D017093:Liver Failure / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011517:Prothrombin Time; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D001663:Bilirubin
keywords: Acute hepatitis E; Anti-hepatitis B virus treatment; Chronic hepatitis B virus infection; Clinical profile; Superinfection