Hepatitis E virus infection and acute‐on‐chronic liver failure in West Africa: a case–control study from The Gambia. Issue 3 (1st December 2015)

• Record Type: Journal Article
• Authors: Shimakawa, Y.; Njai, H. F.; Takahashi, K.; Berg, L.; Ndow, G.; Jeng‐Barry, A.; Ceesay, A.; Tamba, S.; Opoku, E.; Taal, M.; Akbar, S. M. F.; Arai, M.; D'Alessandro, U.; Taylor‐Robinson, S. D.; Njie, R.; Mishiro, S.; Thursz, M. R.; Lemoine, M.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 43:Issue 3(2016)
• Page Start: 375
• Page End: 384
• Publication Date: 2015-12-01
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13484
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: In sub‐Saharan Africa, it is unknown whether hepatitis E virus (HEV) infection is a common precipitating event of acute‐on‐chronic liver failure (ACLF). Aims: To estimate the prevalence of HEV infection in general population and assess whether HEV is a common trigger of ACLF in cirrhotic patients in The Gambia, West Africa. Methods: We first conducted an HEV sero‐survey in healthy volunteers. We then tested cirrhotic patients with ACLF (cases) and compensated cirrhosis (controls) for anti‐HEV IgG as a marker of exposure to HEV, and anti‐HEV IgA and HEV RNA as a marker of recent infection. We also described the characteristics and survival of the ACLF cases and controls. Results: In the healthy volunteers ( n = 204), 13.7% (95% CI: 9.6–19.2) were positive for anti‐HEV IgG, and none had positive HEV viraemia. After adjusting for age and sex, the following were associated with positive anti‐HEV IgG: being a Christian, a farmer, drinking water from wells, handling pigs and eating pork. In 40 cases (median age: 45 years, 72.5% male) and 71 controls (39 years, 74.6% male), ≥70% were infected with hepatitis B virus. Although hepatitis B flare and sepsis were important precipitating events of ACLF, none had marker of acute HEV. ACLF cases had high (70.0%) 28‐day mortality. Conclusions: Hepatitis E virus infection is endemic in The Gambia, where both faecal‐oral route (contaminated water) and zoonotic transmission (pigs/pork meat) may be important. However, acute HEV was not a common cause of acute‐on‐chronic liver failure in The Gambia.