Acute hepatitis E superinfection leading to chronic hepatitis B reactivation

Hepatit B Yüzey Antijeni (HBsAg) Pozitif Hastalarda Hepatit A ve Hepatit E Virüsü Seropozitifliği

Introduction: In this study, we aimed to determine the anti-HAV IgG and anti-HEV IgG seroprevalence in patients admitted to our clinic with Hepatitis B surface antigen (HBsAg) positivity. Material and Method: Data of 1827 patients followed up on for HBsAg positivity between 2010 and 2019 were obtained retrospectively. Results: The mean age of 1827 HBsAg positive patients was 42.71±14.84; there were 730 (39.96%) female patients and 1097 (60.04%)male. Of the 923 HBsAg positive patients whose anti-HAV IgG was measured, 830(%89,9) were detected to be positive, and 93 (10.1%) negative. Anti-HAV IgG negative patients were most often in the 21-30 age range (38.7%). Age medians were significantly different between the groups (p=0.001). HBsAg positive patients who were also positive for anti-HAV IgG tended to be older than anti-HAV IgG negative patients. In contrast, there was no significant difference in gender between anti-HAV IgG negative and positive patients (p=0.674). Of 143 HBsAg positive patients who were tested for anti-HEV-IgG, five were positive (3.5%). Conclusion: It is of interest that we found a lower rate of anti-HAV IgG positivity in young Chronic Hepatitis B patients. When hepatitis B virus is detected, a test for anti-HAV IgG should be requested from patients and if the test result is negative, the patient should be vaccinated. Our study data analysis also revealed a low anti-HEV IgG positivity.

Hepatitis E virus infection during pregnancy

BACKGROUND

Hepatitis E virus (HEV) generally causes self-limiting viral hepatitis. However, in pregnant women, HEV infection can be severe and has been associated with up to 30% mortality in the third trimester. Additionally, HEV infection in pregnancy is also associated with high rates of preterm labor and vertical transmission.

MAIN BODY

HEV is now recognized as a global health problem in both developing and industrialized countries. HEV can be transmitted via the fecal-oral route, zoonotic route, and blood transfusion route. An altered immune status, hormonal levels, and viral factors may be related to the severity of the disease. Currently, no established treatment is available for HEV in pregnant women. A Chinese vaccine has been demonstrated to be protective against HEV in the general population and seems to be safe in pregnancy; however, its safety and efficacy in a large population of pregnant women remain to be determined.

CONCLUSION

This review summarizes the current knowledge about HEV infection during pregnancy and focuses on the epidemiology, clinical manifestations, mechanisms underlying severe liver injury, and management and prevention of HEV infection during pregnancy. Considering that HEV infection during pregnancy may result in poor outcomes, screening for and monitoring HEV infection early in pregnancy should be taken into account. In addition, a better understanding of the pathogenesis will help to develop potential treatment strategies targeting HEV infection in pregnancy.

Life cycle and morphogenesis of the hepatitis E virus

Hepatitis E virus (HEV) is transmitted primarily via contaminated water and food by the fecal oral route and causes epidemics in developing countries. In industrialized countries, zoonotic transmission of HEV is prevalent. In addition, HEV is the major cause of acute hepatitis in healthy adults and can cause chronic hepatitis in immunocompromised patients, with pregnant HEV-infected women having increased mortality rates of approximately 25%. HEV was once an understudied and neglected virus. However, in recent years, the safety of blood products with respect to HEV has increasingly been considered to be a public health problem. The establishment of HEV infection models has enabled significant progress to be made in understanding its life cycle. HEV infects cells via a receptor (complex) that has yet to be identified. The HEV replication cycle is initiated immediately after the (+) stranded RNA genome is released into the cell cytosol. Subsequently, infectious viral particles are released by the ESCRT complex as quasi-enveloped viruses (eHEVs) into the serum, whereas feces and urine contain only nonenveloped infectious viral progeny. The uncoating of the viral envelope takes place in the biliary tract, resulting in the generation of a nonenveloped virus that is more resistant to environmental stress and possesses a higher infectivity than that of eHEV. This review summarizes the current knowledge regarding the HEV life cycle, viral morphogenesis, established model systems and vaccine development.