The role of hepatitis E virus infection in Adult Americans with acute liver failure Journal Article

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Authors: Fontana, R. J.; Engle, R. E.; Scaglione, S; Araya, V.; Shaikh, O.; Tillman, H.; Attar, N.; Purcell, R. H.; Lee, W. M.; US Acute Liver Failure Study Group.
Article Title: The role of hepatitis E virus infection in Adult Americans with acute liver failure
Abstract: Acute hepatitis E virus (HEV) infection is a leading cause of acute liver failure (ALF) in many developing countries yet rarely identified in Western countries. Since antibody testing for HEV infection is not routinely obtained, we hypothesized that HEV-related ALF might be present and unrecognized in North American ALF patients. Serum samples of 681 adults enrolled in the US ALF Study Group were tested for anti-HEV IgM and anti-HEV IgG levels. Subjects with a detectable anti-HEV IgM also underwent testing for HEV-RNA. Mean patient age was 41.8 years, 32.9% male, and ALF etiologies included acetaminophen hepatotoxicity (29%), indeterminate ALF (23%), idiosyncratic DILI (22%), acute HBV infection (12%), autoimmune hepatitis (12%) and pregnancy related ALF (2%). Three men ages 36, 39, and 70 demonstrated repeatedly detectable anti-HEV IgM but all were HEV RNA negative and had other putative diagnoses. The latter two subjects died within 3 and 11 days of enrollment while the 36 year old underwent emergency liver transplantation on study day 2. At admission, 294 (43.4%) of the ALF patients were anti-HEV IgG positive with the seroprevalence being highest in those from the Midwest (50%) and lowest in those from the Southeast (28%). Anti-HEV IgG + subjects were significantly older, less likely to have APAP overdose, and had a lower overall 3 week survival compared to anti-HEV IgG - subjects (63% vs 70%, p= 0.018). CONCLUSIONS: Acute HEV infection is very rare in adult Americans with ALF (i.e., 0.4%) and could not be implicated in any indeterminate, autoimmune, or pregnancy-related ALF cases. Prior exposure to HEV with detectable anti-HEV IgG was significantly more common in the ALF patients compared to the general US population. This article is protected by copyright. All rights reserved.
Journal Title: Hepatology (Baltimore, Md.)
ISSN: 1527-3350; 0270-9139
Publisher: by the American Association for the Study of Liver Diseases  
Date Published: 2016
Language: ENG
DOI/URL:

10.1002/hep.28649
Notes: LR: 20160610; CI: (c) 2016; GR: U01 DK058369/DK/NIDDK NIH HHS/United States; JID: 8302946; OTO: NOTNLM; 2016/01/27 [received]; 2016/04/04 [revised]; 2016/05/17 [accepted]; aheadofprint