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© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

INTRODUCTION:

The aim of this study was to determine the role of hepatitis E virus (HEV) infection in a large cohort of prospectively enrolled patients with severe acute liver injury (ALI).

METHODS:

Serum samples from 594 consecutive adults enrolled between 2008 and 2018 in the US Acute Liver Failure Study Group ALI registry were tested for anti-HEV IgM and anti-HEV IgG levels. Those with detectable anti-HEV IgM underwent further testing for HEV RNA using real-time polymerase chain reaction.

RESULTS:

The median age of patients was 38 years; 41% were men and 72% Caucasian. Etiologies of ALI included acetaminophen hepatotoxicity (50%), autoimmune hepatitis (8.9%), hepatitis B virus (8.9%), and idiosyncratic drug-induced liver injury (7.9%). Overall, 62 patients (10.4%) were negative for anti-HEV IgM but positive for IgG, whereas only 3 men (0.5%) were positive for both anti-HEV IgM and IgG. These 3 cases were initially diagnosed as having indeterminate, HEV, and hepatitis B virus-related ALI. One of these patients had detectable HEV RNA genotype 3, and another anti-HEV IgM+ patient had detectable HEV antigens by immunohistochemistry on liver biopsy. On multivariate modeling, older (odds ratio: 1.99) and non-Caucasian subjects (odds ratio: 2.92) were significantly more likely to have detectable anti-HEV IgG (P < 0.0001).

DISCUSSION:

Acute HEV infection is an infrequent cause of ALI in hospitalized North American adults. The anti-HEV IgG+ patients were significantly older and more likely to be non-Caucasian. These data are consistent with other population-based studies that indicate exposure to HEV in the general US population is declining over time and might reflect a cohort effect.

Details

Title
Role of Hepatitis E Virus Infection in North American Patients With Severe Acute Liver Injury
Author
Fontana, Robert J 1 ; Engle, Ronald E 2 ; Gottfried, Michelle 3 ; Hammed Bilal 4 ; Hanje, James 5 ; Durkalski Valerie 3 ; Kleiner, David E 6 ; Nguyen, Hanh 2 ; Nishimura Norihisa 2 ; Lee, William M 7 ; Farci Patrizia 2 

 Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA; 
 Hepatic Pathogenesis Section, Laboratory of Infectious Diseases, NIAID, Bethesda, Maryland, USA; 
 Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA; 
 Department of Medicine, UCSF, San Francisco, California, USA; 
 Department of Medicine, Ohio State University, Columbus, Ohio, USA; 
 Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA; 
 Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA 
Pages
e00273
Section
Article
Publication year
2020
Publication date
Nov 2020
Publisher
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
e-ISSN
2155384X
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2507459385
Copyright
© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.