Universidade Federal de São Paulo, Divisão de Doenças Infeccionsas, Departamento de Medicina, São Paulo, SP, Brazil.
Universidade Federal de São Paulo, Divisão de Doenças Infeccionsas, Departamento de Medicina, São Paulo, SP, Brazil.
Braz J Infect Dis. 2019 Jan-Feb;23(1):45-52. doi: 10.1016/j.bjid.2019.02.002. Epub 2019 Mar 2.
Hepatitis E virus (HEV) infection in patients with pre-existing liver disease has shown high morbidity and lethality. The consequences of HEV superinfection in patients with chronic hepatitis C virus (HCV) infection are not fully understood. This study aimed to evaluate the association between the presence of anti-HEV antibodies, liver cirrhosis, and insulin resistance.
A total of 618 patients chronically infected with HCV were included from three reference centers for viral hepatitis in São Paulo, Brazil. Presence of anti-HEV IgG was assessed by enzyme-linked immunosorbent assay (WANTAI HEV-IgG ELISA).
The seroprevalence of anti-HEV in patients with cirrhosis was significantly higher than in patients without cirrhosis (13.2% vs 8%, OR=1.74, p=0.04). Seropositivity for anti-HEV, adjusted for sex, age, and HCV genotype showed an association trend with hepatic cirrhosis (aOR=1.75, p=0.059). Presence of HEV antibodies, adjusted for age, body mass index and cirrhosis, was shown to be independently associated with insulin resistance (aOR: 4.39; p=0.045).
Patients with chronic hepatitis C are under risk of hepatitis E virus superinfection in Brazil. The trend toward association between cirrhosis and previous HEV infection suggests that it may accelerate liver fibrosis in patients with chronic hepatitis C. In addition, previous infection by HEV is independently associated with insulin resistance in the studied population, which may be an extra-hepatic manifestation of hepatitis E that persists after resolution of the active infection, and may contribute to fibrosis progression.
患有基础肝病的戊型肝炎病毒 (HEV) 感染者发病率和死亡率均较高。慢性丙型肝炎病毒 (HCV) 感染者中 HEV 再感染的后果尚不完全清楚。本研究旨在评估抗-HEV 抗体、肝硬化和胰岛素抵抗之间的关系。
从巴西圣保罗三个病毒性肝炎参考中心纳入了 618 例慢性 HCV 感染者。采用酶联免疫吸附试验（万泰 HEV-IgG ELISA）检测抗-HEV IgG。
肝硬化患者抗-HEV 的血清阳性率明显高于无肝硬化患者（13.2% vs 8%，OR=1.74，p=0.04）。抗-HEV 血清阳性与肝硬化相关，经性别、年龄和 HCV 基因型调整后具有关联趋势（aOR=1.75，p=0.059）。在调整了年龄、体重指数和肝硬化后，HEV 抗体的存在与胰岛素抵抗独立相关（aOR：4.39；p=0.045）。
巴西慢性丙型肝炎患者存在 HEV 再感染的风险。肝硬化与既往 HEV 感染之间的关联趋势表明，HEV 可能会加速慢性丙型肝炎患者的肝纤维化。此外，在本研究人群中，既往感染 HEV 与胰岛素抵抗独立相关，这可能是 HEV 的一种肝外表现，在急性感染消退后持续存在，并可能导致纤维化进展。
