title: Hepatitis E virus infection and acute-on-chronic liver failure in West Africa: a case-control study from The Gambia.
abstract: 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).
  
  
  OBJECTIVE
  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.
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Shimakawa
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.
authors.forename: H F
authors.initials: HF
authors.lastname: Njai
authors.affiliation: Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|Hepatology Unit, Department of Medicine, Imperial College London, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Berg
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|Hepatology Unit, Department of Medicine, Imperial College London, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Ndow
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.
authors.forename: A
authors.initials: A
authors.lastname: Jeng-Barry
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.
authors.forename: A
authors.initials: A
authors.lastname: Ceesay
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.
authors.forename: S
authors.initials: S
authors.lastname: Tamba
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|Hepatology Unit, Department of Medicine, Imperial College London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Opoku
authors.affiliation: Ministry of Health and Social Welfare, Banjul, The Gambia.
authors.forename: M
authors.initials: M
authors.lastname: Taal
authors.affiliation: Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan.
authors.forename: S M F
authors.initials: SM
authors.lastname: Akbar
authors.affiliation: Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Arai
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.
authors.forename: U
authors.initials: U
authors.lastname: D'Alessandro
authors.affiliation: Hepatology Unit, Department of Medicine, Imperial College London, London, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Taylor-Robinson
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Banjul, The Gambia.
authors.forename: R
authors.initials: R
authors.lastname: Njie
authors.affiliation: Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Mishiro
authors.affiliation: Hepatology Unit, Department of Medicine, Imperial College London, London, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Thursz
authors.affiliation: MRC Unit The Gambia, Banjul, The Gambia.|Hepatology Unit, Department of Medicine, Imperial College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lemoine
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000453:epidemiology*; D000328:Adult; D000383:Agriculture; D016022:Case-Control Studies; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000453:epidemiology*; D016752:Hepatitis E virus / Q000235:genetics; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral; D012959:Socioeconomic Factors; D014881:Water Supply
chemical_list: D006508:Hepatitis Antibodies; D012367:RNA, Viral