Hepatitis E Virus Does Not Contribute to Hepatic Decompensation Among Patients With Advanced Chronic Hepatitis C

Niharika Samala, Elizabeth C. Wright, A. Gretchen Buckler, Vanessa Vargas, Kirti Shetty, K. Rajender Reddy, Michael R. Lucey, Harvey J. Alter, Jay H. Hoofnagle, Marc G. Ghany

Research output: Contribution to journalArticle

Abstract

Background & Aims: Hepatitis E (HEV) can cause acute-on-chronic liver failure in persons with pre-existing liver disease. We investigated whether HEV infection contributes to hepatic decompensation in patients with previously stable, advanced chronic hepatitis C. Methods: We performed a case-control study using stored serum samples from subjects enrolled in the randomized phase of the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis Trial (n = 1050; mean age, 51 y; 70% male; 40% with cirrhosis at baseline). Cases were subjects who developed hepatic decompensation within a 24-week period. Controls (3 per case) were subjects without hepatic decompensation matched for fibrosis stage and followed up for a similar period. A serum sample obtained within 6 months after the decompensation event in cases and the same follow-up period in controls were tested for anti-HEV IgG. Subjects with a positive result had a baseline sample similarly tested for anti-HEV IgG. We measured levels of anti-HEV IgM and HEV RNA in blood samples from incident cases. Results: Of the 1050 subjects analyzed, 314 (30%) experienced a clinical event. Of the 314 subjects who experienced decompensation as defined, 89 (28%) were tested for anti-HEV, along with 267 controls (without decompensation). Similar proportions of cases and controls tested positive for anti-HEV (22.5% and 20.6%, respectively; P = .70). Ten incident HEV infections were identified-4 in cases (4.5%) and 6 in controls (2.2%) (P = .28). HEV RNA was not detected in blood samples from the 10 incident infections. Only 2 of the 4 incident infections among cases were related temporally to the decompensation event. Conclusions: HEV does not appear to be a significant cause of hepatic decompensation among persons with previously stable, advanced chronic hepatitis C in the United States.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
DOIs
StateAccepted/In press - 2016

Keywords

  • CHC
  • Complication
  • HALT-C
  • HCV Infection

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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    Samala, N., Wright, E. C., Buckler, A. G., Vargas, V., Shetty, K., Reddy, K. R., Lucey, M. R., Alter, H. J., Hoofnagle, J. H., & Ghany, M. G. (Accepted/In press). Hepatitis E Virus Does Not Contribute to Hepatic Decompensation Among Patients With Advanced Chronic Hepatitis C. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2015.12.048