HEV superinfection accelerates disease progression in patients with chronic HBV infection and increases mortality in those with cirrhosis
Journal
Journal of Hepatology
Journal Volume
72
Journal Issue
6
Pages
1105-1111
Date Issued
2020
Author(s)
Chang C.T
Yang W.-T
Tsai C.-H
Abstract
Background & Aims: Acute HEV infection causes varying degrees of liver damage. Although liver-related death due to HEV infection alone is rare in healthy individuals, it is unclear whether HEV superinfection is associated with worse outcomes in patients with chronic HBV infection. Thus, we explored whether HEV superinfection was associated with increased incidence of liver-related death, cirrhosis, and hepatocellular carcinoma (HCC). Methods: Serum and data were collected from 2 independent retrospective cohorts of patients with chronic HBV infection, comprising 2,123 patients without cirrhosis and 414 with cirrhosis at baseline, respectively. All the patients were negative for HEV-IgG at enrolment and HEV superinfection was defined by the presence of HEV-IgG seroconversion. Results: In the non-cirrhotic cohort, 46 of 2,123 patients developed HEV superinfection. Though HEV superinfection was only associated with increased incidence of liver-related death in the overall cohort, it was a risk factor for all 3 endpoints (liver-related death, cirrhosis, and HCC) in a subgroup of 723 HBeAg-negative patients with chronic HBV infection. In addition, the 1-year mortality rate after HEV superinfection was higher in 4 patients who developed cirrhosis during the follow-up than in those who did not (50% vs. 2.4%, p = 0.001). To elucidate the perceived relationship between HEV superinfection and risk of mortality, an independent cohort of cirrhotic patients (n = 414) was further analyzed to control for the inherent increase in mortality risk due to cirrhosis. The 10 cirrhotic patients with HEV superinfection had a higher 1-year mortality rate than those without (30% vs. 0%, p <0.001). Conclusions: In both cohorts of patients with chronic HBV infection, acute HEV superinfection increases the risk of liver-related death, especially in those with cirrhosis. Lay summary: The mortality caused by acute hepatitis E virus infection is usually low in the healthy population, but it is unclear how it affects patients with chronic hepatitis B virus infection, as they already have compromised liver function. Our data show that the 1-year mortality rate is 35.7% in patients with hepatitis B-related cirrhosis who contract hepatitis E virus. Hepatitis E may accelerate disease progression in patients with chronic hepatitis B. ? 2020 European Association for the Study of the Liver
SDGs
Other Subjects
hepatitis B surface antigen; hepatitis B(e) antigen; hepatitis E antibody; hepatitis B(e) antigen; immunoglobulin G; virus antibody; adult; Article; ascites; bacterial peritonitis; chronic hepatitis B; cohort analysis; controlled study; decompensated liver cirrhosis; disease association; disease exacerbation; echography; female; follow up; hepatic encephalopathy; hepatitis E; hepatorenal syndrome; human; incidence; liver cell carcinoma; liver cirrhosis; liver function test; major clinical study; male; mortality; mortality rate; prevalence; priority journal; retrospective study; risk factor; seroconversion; stomach varices bleeding; superinfection; aged; blood; chronic hepatitis B; comorbidity; Hepatitis B virus; hepatitis E; Hepatitis E virus; immunology; liver cell carcinoma; liver cirrhosis; liver tumor; middle aged; superinfection; Taiwan; virology; young adult; Adult; Aged; Antibodies, Viral; Carcinoma, Hepatocellular; Comorbidity; Disease Progression; Female; Follow-Up Studies; Hepatitis B e Antigens; Hepatitis B virus; Hepatitis B, Chronic; Hepatitis E; Hepatitis E virus; Humans; Immunoglobulin G; Incidence; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Superinfection; Taiwan; Young Adult
Publisher
Elsevier B.V.
Type
journal article