title: Hepatitis E Virus Does Not Contribute to Hepatic Decompensation Among Patients With Advanced Chronic Hepatitis C.
abstract: Hepatitis E (HEV) can cause acute-on-chronic liver failure in persons with pre-existing liver disease. We investigated whether HEV infection contributes to hepatic decompensation in patients with previously stable, advanced chronic hepatitis C.
  
  
  
  We performed a case-control study using stored serum samples from subjects enrolled in the randomized phase of the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis Trial (n = 1050; mean age, 51 y; 70% male; 40% with cirrhosis at baseline). Cases were subjects who developed hepatic decompensation within a 24-week period. Controls (3 per case) were subjects without hepatic decompensation matched for fibrosis stage and followed up for a similar period. A serum sample obtained within 6 months after the decompensation event in cases and the same follow-up period in controls were tested for anti-HEV IgG. Subjects with a positive result had a baseline sample similarly tested for anti-HEV IgG. We measured levels of anti-HEV IgM and HEV RNA in blood samples from incident cases.
  
  
  
  Of the 1050 subjects analyzed, 314 (30%) experienced a clinical event. Of the 314 subjects who experienced decompensation as defined, 89 (28%) were tested for anti-HEV, along with 267 controls (without decompensation). Similar proportions of cases and controls tested positive for anti-HEV (22.5% and 20.6%, respectively; P = .70). Ten incident HEV infections were identified-4 in cases (4.5%) and 6 in controls (2.2%) (P = .28). HEV RNA was not detected in blood samples from the 10 incident infections. Only 2 of the 4 incident infections among cases were related temporally to the decompensation event.
  
  
  
  HEV does not appear to be a significant cause of hepatic decompensation among persons with previously stable, advanced chronic hepatitis C in the United States.
authors.affiliation: Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Niharika
authors.initials: N
authors.lastname: Samala
authors.affiliation: Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wright
authors.affiliation: Infectious Disease Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland.
authors.forename: A Gretchen
authors.initials: AG
authors.lastname: Buckler
authors.affiliation: Infectious Disease Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Vargas
authors.affiliation: Division of Gastroenterology, Department of Medicine, Johns Hopkins University, Sibley Memorial Hospital, Washington, District of Columbia.
authors.forename: Kirti
authors.initials: K
authors.lastname: Shetty
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, Madison, Wisconsin.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lucey
authors.affiliation: Infectious Disease Section, Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland.
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Alter
authors.affiliation: Liver Diseases Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Hoofnagle
authors.affiliation: Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. Electronic address: MarcG@intra.niddk.nih.gov.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Ghany
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000453:epidemiology*; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications*; D016751:Hepatitis E / Q000150:complications*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D014481:United States
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D012367:RNA, Viral
keywords: CHC; Complication; HALT-C; HCV Infection