Abstract | BACKGROUND AND AIM: Hepatitis E virus (HEV) has recently been implicated in episodes of acute decompensation in patients having underlying chronic liver disease (CLD) of varying etiology. However, HEV as a cause of acute exacerbation of previously asymptomatic and unrecognized hepatitis B virus (HBV)-infected patients is less well described. The aim of the present study was to investigate the etiology of acute exacerbation of previously asymptomatic and unrecognized HBV-infected patients and to evaluate the relative role of HEV. We also investigated the effect of superinfection on the clinical spectrum of underlying HBV infection. METHODS: RESULTS: Of the 43 patients, 21 were hepatitis e antigen ( HBeAg) (+) (Gr.1) and 22 HBeAg (-) (Gr.2) at presentation. In Gr.1, only two (9.5%) had superinfection (both with hepatitis A virus), whereas in Gr.2, 11 (50%) had superinfection (27.3% hepatitis E, 13.6% hepatitis A and 9.1% both) (P = 0.007). In Gr.1, the remaining 19 (90.5%) patients had spontaneous exacerbation (immune clearance with spontaneous seroconversion) whereas in Gr.2, the remaining 11 (50%) had spontaneous exacerbation (due to reactivation). Overall, HEV superinfection contributed to 20% of acute exacerbation episodes and, in particular, 36% of episodes in initially HBeAg (-) patients. Time to alanine aminotransferase normalization was longer in patients with superinfection (n = 13) as compared to spontaneous exacerbation ( n = 30) (median [range] 36 [8-48]vs 16 [6-36] weeks, P = 0.001). During convalescence, there was no significant difference between histological activity index score (median [range] 8 [4-11]vs 8 [4-16] weeks, P = 0.629) and fibrosis scores (median [range] 3.5 [1-4]vs 2 [1-4] weeks, P = 0.099] on liver biopsy after recovery among patients with acute exacerbation due to superinfection and spontaneous exacerbation. CONCLUSIONS: Acute exacerbations in HBeAg (+) patients are most often due to spontaneous viral activation, while in HBeAg (-) patients, superinfection with non-B hepatitis viruses and spontaneous viral activation are equally common. HEV is an important cause of acute exacerbation in previously asymptomatic and unrecognized patients with HBV-related CLD.
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Authors | Manoj Kumar, Barjesh C Sharma, Shiv K Sarin |
Journal | Journal of gastroenterology and hepatology
(J Gastroenterol Hepatol)
Vol. 23
Issue 6
Pg. 883-7
(Jun 2008)
ISSN: 1440-1746 [Electronic] Australia |
PMID | 18070014
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Biomarkers
- Hepatitis B Core Antigens
- Hepatitis B Surface Antigens
- Hepatitis B e Antigens
- Immunoglobulin M
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Topics |
- Adult
- Biomarkers
(blood)
- Diagnosis, Differential
- Female
- Hepatitis B Core Antigens
(blood)
- Hepatitis B Surface Antigens
(blood)
- Hepatitis B e Antigens
(blood)
- Hepatitis B virus
(isolation & purification)
- Hepatitis B, Chronic
(complications, diagnosis, immunology)
- Hepatitis E
(complications, diagnosis, immunology)
- Hepatitis E virus
(isolation & purification)
- Humans
- Immunoglobulin M
(blood)
- Liver Function Tests
- Male
- Middle Aged
- Retrospective Studies
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