Published online Sep 21, 2013. doi: 10.3748/wjg.v19.i35.5904
Revised: July 24, 2013
Accepted: August 4, 2013
Published online: September 21, 2013
AIM: To investigate the influence of chronic hepatitis B virus (HBV) infection [based on the status of hepatitis B e antigen (HBeAg), HBV DNA, and cirrhosis] on superimposed acute hepatitis E.
METHODS: A total of 294 patients were recruited from the Department of Infectious Diseases of the Third Affiliated Hospital, Sun Yat-sen University, from January 2003 to January 2012. The patients were classified into two groups: an HBV + hepatitis E virus (HEV) group (a group with chronic HBV infection that was superinfected with acute hepatitis E, n = 118) and an HEV group (a group with acute hepatitis E, n = 176). We retrospectively analyzed and compared the clinical features of the two groups. Statistical analyses were performed using the χ2 test or Fisher’s exact test for categorical variables and the Student’s t test for continuous variables. A P value < 0.05 was considered statistically significant.
RESULTS: The peak values of prothrombin time, serum total bilirubin, and Model for End-Stage Liver Disease scores were significantly higher in the HBV + HEV group. More patients in the HBV + HEV group had complications (39.8% vs 16.5%, P = 0.000) and developed liver failure (35.6% vs 8.5%, P = 0.000). Additionally, the mortality of the HBV + HEV group was significantly higher (20.3% vs 7.4%, P = 0.002). Further analysis of the HBV + HEV group showed that there were no significant differences in complication occurrence, liver failure incidence, or mortality between patients with different HBeAg and HBV DNA statuses. However, in patients with underlying cirrhosis, complication occurrence and liver failure incidence significantly increased. In total, 12.7% of the patients in the HBV + HEV group received anti-HBV treatment, but this therapy failed to reduce mortality in patients who developed liver failure.
CONCLUSION: The presence of underlying cirrhosis in chronic HBV infection results in more severe clinical outcomes with superimposed acute hepatitis E. Anti-HBV treatment cannot improve the prognosis of liver failure caused by HBV-HEV superinfection.
Core tip: Previous studies have shown that chronic hepatitis B virus (HBV) infection has a negative impact on superimposed acute hepatitis E. However, it remains unknown whether the disease severity of acute hepatitis E correlates with the underlying HBV replication status or with liver histological lesions. Our study showed that the disease severity of acute hepatitis E correlated not with the HBV replication status (based on the status of hepatitis B e antigen and HBV DNA), but rather with the presence of underlying cirrhosis. This finding raised the question of whether anti-HBV treatment improves the outcome of liver failure caused by HBV-hepatitis E virus superinfection. We found that anti-HBV treatment could not improve the prognosis of such liver failure.