MRC Unit The Gambia, Banjul, The Gambia.
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
Aliment Pharmacol Ther. 2016 Feb;43(3):375-84. doi: 10.1111/apt.13484. Epub 2015 Dec 1.
In sub-Saharan Africa, it is unknown whether hepatitis E virus (HEV) infection is a common precipitating event of acute-on-chronic liver failure (ACLF).
To estimate the prevalence of HEV infection in general population and assess whether HEV is a common trigger of ACLF in cirrhotic patients in The Gambia, West Africa.
We first conducted an HEV sero-survey in healthy volunteers. We then tested cirrhotic patients with ACLF (cases) and compensated cirrhosis (controls) for anti-HEV IgG as a marker of exposure to HEV, and anti-HEV IgA and HEV RNA as a marker of recent infection. We also described the characteristics and survival of the ACLF cases and controls.
In the healthy volunteers (n = 204), 13.7% (95% CI: 9.6-19.2) were positive for anti-HEV IgG, and none had positive HEV viraemia. After adjusting for age and sex, the following were associated with positive anti-HEV IgG: being a Christian, a farmer, drinking water from wells, handling pigs and eating pork. In 40 cases (median age: 45 years, 72.5% male) and 71 controls (39 years, 74.6% male), ≥70% were infected with hepatitis B virus. Although hepatitis B flare and sepsis were important precipitating events of ACLF, none had marker of acute HEV. ACLF cases had high (70.0%) 28-day mortality.
Hepatitis E virus infection is endemic in The Gambia, where both faecal-oral route (contaminated water) and zoonotic transmission (pigs/pork meat) may be important. However, acute HEV was not a common cause of acute-on-chronic liver failure in The Gambia.
在撒哈拉以南非洲，尚不清楚戊型肝炎病毒（HEV）感染是否是慢性加急性肝衰竭（ACLF）的常见诱发因素。
评估冈比亚普通人群中 HEV 感染的流行率，并评估 HEV 是否是西非冈比亚肝硬化患者 ACLF 的常见诱因。
我们首先在健康志愿者中进行了 HEV 血清学调查。然后，我们检测了患有 ACLF（病例）和代偿性肝硬化（对照）的肝硬化患者的抗-HEV IgG，以作为暴露于 HEV 的标志物，并检测了抗-HEV IgA 和 HEV RNA，以作为近期感染的标志物。我们还描述了 ACLF 病例和对照的特征和生存情况。
在健康志愿者（n=204）中，13.7%（95%CI：9.6-19.2）的人抗-HEV IgG 阳性，且无人出现 HEV 病毒血症。在调整年龄和性别后，以下因素与抗-HEV IgG 阳性相关：基督教徒、农民、饮用井水、接触猪和食用猪肉。在 40 例病例（中位年龄：45 岁，72.5%为男性）和 71 例对照（39 岁，74.6%为男性）中，≥70%的人感染了乙型肝炎病毒。尽管乙型肝炎病毒爆发和脓毒症是 ACLF 的重要诱发因素，但均无急性 HEV 的标志物。ACLF 病例的 28 天死亡率高达 70.0%。
HEV 感染在冈比亚流行，粪-口途径（受污染的水）和动物源性传播（猪/猪肉）都可能是重要的传播途径。然而，急性 HEV 并不是冈比亚 ACLF 的常见病因。
