HEPATOLOGY

liver411

August 2002 . Volume 36 . Number 2

Hepatitis E virus superinfection in patients with chronic liver disease

Saeed S. Hamid1 Muslim Atiq1 Farooq Shehzad1 Aneela Yasmeen2
Tayyabun Nissa2 Abdul Salam1 Anwar Siddiqui2 Wasim Jafri1

Abstract
Infection with hepatitis A virus (HAV) can cause severe illness in adult
patients with chronic liver disease (CLD) caused by hepatitis C. In endemic
areas such as South Asia, however, most adult patients already have been
exposed to HAV but could still be susceptible to hepatitis E virus (HEV)
infection. We document that HEV superinfection in 4 of our CLD patients
caused severe liver decompensation. We then determined the seroprevalence of HAV and HEV in 233 patients with stable CLD, with the goal of defining the need for protection against these viruses in these patients. Overall, 41 (17.5%) of 233 CLD patients were HEV antibody immunoglobulin G (IgG)-positive, and 228 of 233 (97.8%) were HAV IgG-positive. As controls, we tested 90 age- and sex-matched healthy volunteer blood donors for HAV and HEV antibodies IgG. There was no difference in the percentage of CLD patients and blood donors positive for HEV antibody IgG (17.7% vs. 17.5%) or for HAV IgG (97.8% vs. 94%). No differences were observed in the severity of liver disease between previously HEV-exposed and -nonexposed patients. In conclusion, superinfection with HEV in patients with underlying CLD can
cause severe hepatic decompensation leading to increased morbidity and
mortality. The large majority of adult CLD patients in endemic countries are
vulnerable to infection with HEV, but are protected against hepatitis A, and
are ideal candidates for an HEV vaccine. (HEPATOLOGY 2002;36:474-478.)

Publishing and Reprint Information
From the Departments of 1Medicine and 2Biochemistry, The Aga Khan
University, Karachi, Pakistan.
Received September 10, 2001.Accepted May 23, 2002.Address reprint requests to: Saeed S. Hamid, FRCP, Department of Medicine, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan. E-mail:
[email protected] ; fax: (92) 21-4934294.Copyright ?2002 by the American Association for the Study of Liver Diseases.
0270-9139/02/3602-0027$35.00/0doi:10.1053/jhep.2002.34856