Hepatitis E in patients with chronic hepatitis C virus infection

Abstract

Background: The impact of hepatitis E virus (HEV) infection in patients with chronic hepatitis C is unknown. The present study aims to evaluate the association between anti-HEV antibody and cirrhosis in patients with chronic hepatitis C virus infection; to estimate the seroprevalence of HEV in this patient population, as well as to describe the associated risk factors; and to evaluate the association between previous HEV infection and insulin resistance. Methods & Materials: From Oct, 2015 to Dec, 2016, a total of 618 chronically infected with hepatitis C virus patients were included from three reference centers of São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI ELISA). Results: Of the 618 patients tested, 10.2% turned out positive for anti-HEV IgG (IC 95% 8.0 – 12.8%). Higher seroprevalence was found independently associated with age grater than 60 years (OR = 2.13; p = 0.001), previous contact with pigs (OR = 2.06; p = 0.02) and hemophilia (OR = 35.69; p = 0.004). After exclusion of 2 transplanted and 26 HIV co-infected patients (n = 590), HEV seropositivity, adjusted for sex, age and HCV genotype, shown an independent association with cirrhosis (OR = 1.84; 95%CI = 1.05 - 3.33; p = 0.036). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (OR: 4.75; 95% CI = 1.26 – 31.3; p = 0.046). Conclusion: Patients with chronic hepatitis C are under risk of HEV superinfection in São Paulo. Contact with pigs is a risk factor for the infection, suggesting a possible zoonosis with oral transmission through contaminated meat or by direct contact with waste from these animals. High prevalence in haemophiliac patients suggests the possibility of parenteral transmission. The association between previous HEV infection and cirrhosis suggests acceleration of fibrosis progression in patients chronically infected by the hepatitis C virus. Previous infection by HEV is independently associated with insulin resistance, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection.