title: Hepatitis E Virus Superinfection and Clinical Progression in Hepatitis B Patients.
abstract: Hepatitis E virus (HEV) infection may cause acute hepatitis and lead to hepatic failure in developing and developed countries. We studied HEV seroprevalences in patients with hepatitis B virus (HBV) infection to understand the consequences of HEV superinfection in a Vietnamese population. This cross-sectional study was conducted from 2012 to 2013 and included 1318 Vietnamese patients with HBV-related liver diseases and 340 healthy controls. The case group included patients with acute (n = 26) and chronic hepatitis B (n = 744), liver cirrhosis (n = 160), hepatocellular carcinoma (n = 166) and patients with both liver cirrhosis and hepatocellular carcinoma (n = 222). Anti-HEV IgG and IgM antibodies were assessed in patients and controls by ELISA. HEV-RNA was identified by PCR assays and sequencing. Seroprevalences of anti-HEV IgG among hepatitis B patients and controls were 45% and 31%, respectively (adjusted P = 0.034). Anti-HEV IgM seroprevalences were 11.6% and 4.7% in patients and controls, respectively (adjusted P = 0.005). Seroprevalences were higher among the elder individuals. When stratifying for patient groups, those with liver cirrhosis had the highest anti-HEV IgG (52%) and anti-HEV IgM (19%) seroprevalences. Hepatitis B patients with current HEV infection had abnormal liver function tests compared to patients with past or without HEV infection. One HEV isolate was retrieved from a patient with both liver cirrhosis and hepatocellular carcinoma and identified as HEV genotype 3. This study indicates high prevalences of HEV infection in Vietnamese HBV patients and among healthy individuals and shows that HEV superinfection may influence the outcome and progression of HBV-related liver disease.
authors: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors: Nghiem Xuan
authors: NX
authors: Hoan
authors: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors: Hoang Van
authors: HV
authors: Tong
authors: Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.
authors: Nicole
authors: N
authors: Hecht
authors: Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany; Department of Molecular Biology, Tran Hung Dao Hospital, Hanoi, Viet Nam.
authors: Bui Tien
authors: BT
authors: Sy
authors: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors: Patrick
authors: P
authors: Marcinek
authors: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors: Christian G
authors: CG
authors: Meyer
authors: Institute of Clinical Infectious Diseases, Tran Hung Dao Hospital, Hanoi, Viet Nam.
authors: Le Huu
authors: le H
authors: Song
authors: Department of Pathophysiology, Vietnam Military Medical University, Ha Dong, Hanoi, Viet Nam.
authors: Nguyen Linh
authors: NL
authors: Toan
authors: Department of Biotechnology, Technical University of Berlin, Berlin, Germany.
authors: Jens
authors: J
authors: Kurreck
authors: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors: Peter G
authors: PG
authors: Kremsner
authors: Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany.
authors: C-Thomas
authors: CT
authors: Bock
authors: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors: Thirumalaisamy P
authors: TP
authors: Velavan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D006508:Hepatitis Antibodies; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000821:virology*; D006515:Hepatitis B virus / Q000502:physiology; D016751:Hepatitis E / Q000150:complications / Q000453:epidemiology* / Q000821:virology*; D016752:Hepatitis E virus / Q000502:physiology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D015995:Prevalence; D012367:RNA, Viral; D016036:Seroepidemiologic Studies; D015163:Superinfection; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies; D012367:RNA, Viral
keywords: AFP, alpha-feto protein; AHB, acute hepatitis B; ALT, alanine amino transferase; AST, aspartate amino transferase; CHB, chronic hepatitis B; HBV infection; HBV, hepatitis B virus; HBV-related liver diseases; HCC, hepatocellular carcinoma; HEV seroprevalence; HEV superinfection; HEV, hepatitis E virus; Hepatitis E virus; IgG, immunoglobulin G; IgM, immunoglobulin M; LC, liver cirrhosis; ORF, open reading frame; PLT, platelets; RBC, red blood cells; WBC, white blood cells