Clinical Outcomes and Prevalence of Hepatitis E Virus (HEV) Among Non-A-C Hepatitis Patients in Egypt

Ibrahim M Sayed; Mohamed A El-Mokhtar; Mahmoud Abdel Rahman Mahmoud; Amal A Elkhawaga; Shereen Gaber; Nermien H Seddek; Lobna Abdel-Wahid; Ahmed M Ashmawy; Enas Ahmed Reda Alkareemy

doi:10.2147/IDR.S289766

Clinical Outcomes and Prevalence of Hepatitis E Virus (HEV) Among Non-A-C Hepatitis Patients in Egypt

Infect Drug Resist. 2021 Jan 12:14:59-69. doi: 10.2147/IDR.S289766. eCollection 2021.

Affiliations

¹ Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
² Department of Internal Medicine, Gastroenterology and Hepatology unit, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
³ Department of Biochemistry, Faculty of Medicine, Minia University, Minia, Egypt.
⁴ Department of Respiratory Care, College of Applied Medical Sciences-Jubail 4030 (CAMSJ), Imam Abdulrahman Bin Faisal University, Al Jubail 35816, Saudi Arabia.

^# Contributed equally.

Abstract

Background: Hepatitis E virus (HEV) is an emerging infectious agent that causes acute hepatitis in developing and developed countries. Diagnosis of HEV infection has not been routinely done in Egyptian hospitals, and clinicians do not prescribe ribavirin (RBV) for acute hepatitis cases of unknown etiology (AHUE). We aimed to screen patients with AHUE for the presence of HEV markers and to determine the complications associated with HEV infection.

Patients and methods: HEV markers (anti-HEV IgM, anti-HEV IgG, and HEV RNA) were assessed in patients with AHUE (n=300) admitted to Assiut University Hospitals. RT-qPCR was used to detect the viral load and sequencing analysis was carried out to determine the genotype of the detected viruses. Phylogenetic tree was constructed to evaluate the genetic relatedness between the isolates. Laboratory parameters and the outcomes of infection were determined.

Results: Acute HEV infection (AHE) was detected in 30 out of 300 (10%) of AHUE patients. Anti-HEV IgM, HEV RNA, and anti-HEV IgG were reported in 83%, 50%, and 43% of the samples, respectively. HEV RNA load ranged from 5×10² IU/mL to 1.1×10⁴ IU/mL. Sequencing of the isolated viruses revealed that five viruses belong to HEV-1 and one isolate belongs to HEV-3 with high homology to the virus recently isolated from the cow and goat milk in the Egyptian villages. Although previous reports showed that attenuated HEV isolates were circulating in Egypt, four out of 30 patients (13%) developed coagulopathy and hepatic encephalopathy and died due to fulminant hepatic failure (FHF) within 3-6 weeks of hospitalization. Age, malignancy, and a history of pre-existing liver diseases were a risky factor for FHF development.

Conclusion: AHE is common in Upper Egypt. Older patients with malignancy and/or a history of liver diseases are risky. HEV diagnosis and treatment become pivotal in Egyptian hospitals to reduce the fatality rate and they should start urgently and promptly.

Keywords: Egypt; acute hepatitis E; diagnosis; fulminant hepatitis failure; ribavirin.

Grants and funding

The authors got funding for this project from the grant office of the Faculty of Medicine, Assiut University, Egypt (Grant ID 2018-07-17-001).