April 09, 2018
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Hepatitis B increases mortality risk in patients with acute hepatitis E

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Chronic hepatitis B virus infection is an independent risk factor for liver-related mortality in people with acute hepatitis E virus infection, according to researchers.

Hepatitis E (HEV) is also associated with a higher mortality rate than acute hepatitis A (HAV), they wrote in Clinical Infectious Diseases.

“Chronic hepatitis B virus [HBV] infection is an important risk factor of liver-related mortality in patients with acute [HEV], who had poorer clinical outcomes compared to those with acute [HAV],” researcher Jimmy Che-To Lai, MD, a professor in the Chinese University of Hong Kong department of medicine and therapeutics, and colleagues wrote. “Further studies on the benefits of [HEV] vaccine in high-risk patients with pre-existing chronic [HBV], particularly those with other important risk factors such as coexisting renal failure, would be warranted.”

Although HAV incidence has declined over the past 10 years, HEV has been on the rise and, according to WHO, caused an estimated 44,000 deaths in 2015 alone. Both diseases are global health problems, especially in poorer countries, the researchers said, but complete data on their outcomes are lacking.

Lai and colleagues sought to assess clinical outcomes of both diseases, as well the potential impact of HBV coinfection with either one. They conducted a retrospective study of data from the Hong Kong Hospital Authority on patients who had tested positive for HAV or HEV between Jan. 1, 2000, and Dec. 31, 2016.

The study’s cohort included 1,068 patients with acute HAV and 846 with acute HEV. Eighty-five patients with HAV (8%) and 114 with HEV (13.5%) also had HBV, the researchers said.

At 30 days after diagnosis, the all-cause mortality rate among patients with HEV was 3.9%, compared with 0.6% among those with HAV. Liver-related mortality rates were 2% and 0.3%, respectively, and the hepatic event rates were 2.8% and 0.3%, respectively.

In patients with HEV, pre-existing renal failure was independently associated with 30-day all-cause mortality (adjusted HR = 3.9; 95% CI, 1.86-8.16), as was being at least 50 years old (aHR = 3.25; 95% CI, 1.08-9.76). Also among those with HEV, testing positive for HBV was independently associated with 30-day liver-related mortality (aHR = 3.34; 95% CI, 1.21-9.23).

The researchers said their findings can help health care officials take pre-emptive measures against the effects of hepatitis coinfection.

“Our study has provided important information to health authorities,” they wrote. “Policy makers of countries or regions endemic with chronic [HBV] infection should be proactive to implement targeted vaccination for HEV in subjects who are at increased risk of mortality.” – by Joe Green

Disclosures: Lai reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.