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Aliment Pharmacol Ther. 2016 Feb;43(3):375-84. doi: 10.1111/apt.13484. Epub 2015 Dec 1.

Hepatitis E virus infection and acute-on-chronic liver failure in West Africa: a case-control study from The Gambia.

Author information

1
MRC Unit The Gambia, Banjul, The Gambia.
2
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
3
Department of Medical Sciences, Toshiba General Hospital, Tokyo, Japan.
4
Hepatology Unit, Department of Medicine, Imperial College London, London, UK.
5
Ministry of Health and Social Welfare, Banjul, The Gambia.
6
The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Banjul, The Gambia.

Abstract

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.

PMID:
26623967
DOI:
10.1111/apt.13484
[Indexed for MEDLINE]
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