Aggravating Effects of Hepatitis E Virus Infection on Patients with Chronic Liver Disease in Ibn-Sina Hospital Sudan

Ashraf Ismail *

Fedail Hospital, Sudan and Mubarak Alkabeer Hospital, Kuwait and University Hospital Sharjah, UAE.

Khalid A. Enan

Department of Virology, Central Laboratory, Ministry of Higher Education and Scientific Research, Khartoum, Sudan.

Abdel Rahim M. El-Hussein

Department of Virology, Central Laboratory, Ministry of Higher Education and Scientific Research, Khartoum, Sudan.

Hala Ibrahim

Ibn-Sina Hospital, Sudan.

Hajar A. Gsemalseed

Ibn-Sina Hospital, Sudan.

Abdel-Moniem Eltayeb Abdo

Ibn-Sina Hospital, Sudan.

*Author to whom correspondence should be addressed.


Abstract

Background: Hepatitis E virus (HEV) is one of the most common causes of acute hepatitis. Sudan is considered as hyper-endemic for HEV. HEV infection in patients with preexisting chronic liver diseases (CLDs) has been reported to result in severe clinical manifestations and poor outcomes. However data on the role of HEV infection in worsening of pre-existing CLD are limited.

Objective: To determine hepatitis E virus (HEV) infection and its effect on severity of CLD.

Methods: A descriptive cross-sectional study that consecutively enrolled 87 CLD patients in Ibn-Sina Specialized Hospital was carried out during the period from August 2020 to December 2020. Data regarding demographics, CLD causes, clinical manifestations and comorbidities were collected. The screening for anti-HEV antibodies was performed in all patients by using enzyme linked immuno-sorbent assay (ELISA).

Results: Hepatitis B virus (HBV) was the commonest etiology of chronic liver diseases being detected in 45/87(51.7%) patients. On the other hand;among all subjects; 43/87(49.4%) patients were HEV seropositive with anti-HEV Ig-G being detected in 32(36.8%) and concurrent anti-HEV Ig-M and Ig-G in 11(12.6%) patients. Jaundice (OR= 3.8, CI95%: 1.5-9.4; P. value=0.004), HCC (OR= 4.1, CI95%: 1.4-11.9; P. value=0.008), child-Pugh class-C (OR= 26, CI95%: 5.4-94.0; P. value=0.000) and child-Pugh class-B (OR= 5.3, CI95%: 1.6-17.0; P. value=0.000) were associated independently with anti-HEV positivity.

Conclusion: The frequency of hepatitis E virus (HEV) among Sudanese patients with chronic liver disease (CLD) was considerably high (mainly past infection- Ig-G). Furthermore, HEV was associated with advanced liver failure statuses (child-Pugh class-B & C), jaundice, and hepatocellular carcinoma.

Keywords: Hepatitis E virus, chronic liver diseases, ELISA, Ibn-Sina Hospital, Sudan


How to Cite

Ismail , Ashraf, Khalid A. Enan, Abdel Rahim M. El-Hussein, Hala Ibrahim, Hajar A. Gsemalseed, and Abdel-Moniem Eltayeb Abdo. 2023. “Aggravating Effects of Hepatitis E Virus Infection on Patients With Chronic Liver Disease in Ibn-Sina Hospital Sudan”. Asian Journal of Research in Infectious Diseases 13 (2):44-51. https://doi.org/10.9734/ajrid/2023/v13i2264.

Downloads

Download data is not yet available.

References

"NHS Choices". Cirrhosis. Retrieved 6 October 2015

Singh D, Memon HN, Shaikh TZ, Shah SZ. Hypoglycemia: Patients with liver cirrhosis. The Professional Medical Journal. 2015 Apr 10;22(04):408-13.

Kaleem Ullah, Abdul Wahab Dogar, Sidhant Ochani, Hafiz Bilal Ahmad.Hepatitis E infection in chronic liver disease patients causing acute on chronic liver failure: Vaccination is need of the hour. BMJ Open Gastro. 2022 December;Vol 9 No 1.

Anabella Fantilli1, Sarah Daniela López Villa, Alina Zerega, Guadalupe Di Cola, Luis López, Maribel Wassaf Martínez, María Belén Pisano and Viviana Elizabeth Ré. Hepatitis E virus infection in a patient with alcohol related chronic liver disease: A case report of acute-on-chronic liver failure. Virology Journal. 2021;18(245):

Available: https://doi.org/10.1186/s12985-021-01714.

Akyüz F, Çavuş B, Pınarbaşı B, Bozacı M, Baran B, Akyuz U, Uyanıkoglu A, Demir K, Beşışık F, Özdil S, Boztaş G. Cryptogenic liver cirrhosis and hepatitis E virus (HEV): Are they related?. Annals of Hepatology. 2019 Jul 1;18(4):585-9.

Mast, MD, MPH EE, Krawczynski, MD, Ph. D K. Hepatitis E: an overview. Annual review of medicine. 1996 Feb;47(1):257-66.

Purdy MA, Krawczynski K. Hepatitis E. Gastroenterology Clinics of North America. 1994 Sep 1;23(3):537-46.

Boccia D, Guthmann JP, Klovstad H, Hamid N, Tatay M, Ciglenecki I. High mortality associated with an outbreak of hepatitis E among displaced persons in Darfur, Sudan. Clinical infectious diseases. 2006 Jun 15;42(12):1679-84.

Hamid et al., 2002; Ramachandran , et al 2004 ; Hoan et al ., 2015.

Khuroo MS, Khuroo MS. Hepatitis E: an emerging global disease–from discovery towards control and cure. Journal of viral hepatitis. 2016 Feb;23(2):68-79.

Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology. 2012 Apr;55(4):988-97.

WHO. Hepatitis E. Geneva. 2017.

Das K, Agarwal A, Andrew R, Frösner GG, Kar P. Role of hepatitis E and other hepatotropic virus in aetiology of sporadic acute viral hepatitis: a hospital based study from urban Delhi. European Journal of Epidemiology. 2000 Oct;16(10):937- 40.

CDC. Hepatitis E FAQs for health professionals. Centers for disease control and prevention. Available at http://www.cdc.gov/hepatitis/hev/hevfaq htm. 2015 Dec 18; Accessed: June 25.2016.

Elduma AH, Zein MM, Karlsson M, Elkhidir IM, Norder H. A single lineage of hepatitis E virus causes both outbreaks and sporadic hepatitis in Sudan. Viruses. 2016 Oct 6;8(10):273.

Narayanan S, Abutaleb A, Sherman KE, Kottilil S. Clinical features and determinants of chronicity in hepatitis E virus infection. Journal of viral hepatitis. 2019 Apr;26(4):414-21.

Ramachandran, J., Eapen, C.E., Kang, G., Abraham P, Hubert DD, Kurian G, Hephzibah J, Mukhopadhya A, Chandy GM. Hepatitis E superinfection produces severe decompensation in patients with chronic liver disease. Journal of gastroenterology and hepatology. 2004;19(2):134-138.

Hamid SS, Atiq M, Shehzad F, Yasmeen A, Nissa T, Salam A, Siddiqui A, Jafri W. Hepatitis E virus superinfection in patients with chronic liver disease. Hepatology. 2002 Aug 1;36(2):474-8.

Acharya SK, Sharma PK, Singh R, Mohanty SK, Madan K, Jha JK, Panda SK. Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death. Journal of hepatology. 2007 Mar 1;46(3):387-94.

Zhang S, Chen C, Peng J, Li X, Zhang D, Yan J, Zhang Y, Lu C, Xun J, Li W, Ling Y. Investigation of underlying comorbidities as risk factors for symptomatic human hepatitis E virus infection. Alimentary Pharmacology & Therapeutics. 2017 Mar;45(5):701-13.

Kondili LA, Chionne P, Porcaro A, Madonna E, Taffon S, Resuli B, Taliani G, Rapicetta M. Seroprevalence of hepatitis E virus (HEV) antibody and the possible association with chronic liver disease: a case-control study in Albania. Epidemiology & Infection. 2006 Feb;134(1):95-101.

El Sayed Zaki M, Othman W. Role of hepatitis E infection in acute on chronic liver failure in Egyptian patients. Liver International. 2011 Aug;31(7):1001-5.

Garg H, Kumar A, Garg V, Sharma P, Sharma BC, Sarin SK. Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure. Digestive and Liver Disease. 2012 Feb 1;44(2):166-71.

Jha AK, Nijhawan S, Rai RR, Nepalia S, Jain P, Suchismita A. Etiology, clinical profile, and inhospital mortality of acute-on-chronic liver failure: a prospective study. Indian Journal of Gastroenterology. 2013 Mar;32(2):108-14.

Kyvernitakis A, Taremi M, Blechacz B, Hwang J, Jiang Y, Mahale P, Torres HA. Impact of hepatitis E virus seropositivity on chronic liver disease in cancer patients with hepatitis C virus infection. Hepatology Research. 2015 Nov;45(11):1146-51.

Fontana RJ, Engle RE, Scaglione S, Araya V, Shaikh O, Tillman H, Attar N, Purcell RH, Lee WM, US. Acute Liver Failure Study Group. The role of hepatitis E virus infection in adult Americans with acute liver failure. Hepatology. 2016 Dec;64(6): 1870-80.

Shimakawa Y, Njai HF, Takahashi K, Berg L, Ndow G, Jeng‐Barry A, Ceesay A, Tamba S, Opoku E, Taal M, Akbar SM. Hepatitis E virus infection and acute‐on‐chronic liver failure in West Africa: a case–control study from The Gambia. Alimentary pharmacology & therapeutics. 2016 Feb;43(3):375-84.

Radha Krishna Y, Saraswat VA, Das K, Himanshu G, Yachha SK, Aggarwal R, Choudhuri G. Clinical features and predictors of outcome in acute hepatitis A and hepatitis E virus hepatitis on cirrhosis. Liver International. 2009 Mar;29(3): 392-8.

Hoan NX, Van Tong H, Hecht N, Sy BT, Marcinek P, Meyer CG, Toan NL, Kurreck J, Kremsner PG, Bock CT, Velavan TP. Hepatitis E virus superinfection and clinical progression in hepatitis B patients. EBioMedicine. 2015 Dec 1;2(12):2080-6.

Atsama MA, Atangana PJ, Noah DN, Moundipa PF, Pineau P, Njouom R. Hepatitis E virus infection as a promoting factor for hepatocellular carcinoma in Cameroon: preliminary observations. International Journal of Infectious Diseases. 2017 Nov 1;64:4-8.