Laboratoire de Virologie, CHRU de Nancy Brabois, Vandœuvre-lès-Nancy, France.
Laboratoire de Chimie Physique et Microbiologie pour les Matériaux et l'Environnement (LCPME), UMR 7564, Vandoeuvre-lès-Nancy, France.
Rev Med Virol. 2019 Nov;29(6):e2078. doi: 10.1002/rmv.2078. Epub 2019 Aug 27.
Hepatitis A (HAV) and E (HEV) viruses are able to cause liver disease in humans. Among the five classical hepatotropic viruses, they are mainly transmitted via the fecal-oral route. Historically, many similarities have thus been described between them according to their incidence and their pathogenicity, especially in countries with poor sanitary conditions. However, recent advances have provided new insights, and the gap is widening between them. Indeed, while HAV infection incidence tends to decrease in developed countries along with public health improvement, HEV is currently considered as an underdiagnosed emerging pathogen. HEV autochthonous infections are increasingly observed and are mainly associated with zoonotic transmissions. Extra hepatic signs resulting in neurological or renal impairments have also been reported for HEV, as well as a chronic carrier state in immunocompromised patients, arguing in favor of differential pathogenesis between those two viruses. Recent molecular tools have allowed studies of viral genome variability and investigation of links between viral plasticity and clinical evolution. The identification of key functional mutations in viral genomes may improve the knowledge of their clinical impact and is analyzed in depth in the present review.
甲型肝炎（HAV）和戊型肝炎（HEV）病毒能够导致人类肝脏疾病。在这五种经典的嗜肝病毒中，它们主要通过粪-口途径传播。历史上，根据它们的发病率和致病性，在卫生条件较差的国家，人们对它们之间有许多相似之处进行了描述。然而，最近的进展提供了新的见解，它们之间的差距正在扩大。事实上，虽然随着公共卫生的改善，发达国家的 HAV 感染发病率呈下降趋势，但 HEV 目前被认为是一种未被充分诊断的新兴病原体。HEV 本土感染越来越多，主要与动物源性传播有关。HEV 还可引起肝外表现，导致神经或肾脏损害，以及免疫功能低下患者的慢性携带状态，这表明这两种病毒的发病机制存在差异。最近的分子工具允许对病毒基因组的变异性进行研究，并调查病毒可塑性与临床演变之间的联系。对病毒基因组中关键功能突变的鉴定可以提高对其临床影响的认识，这在本综述中进行了深入分析。
