Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA.
Minnesota Department of Health, Minneapolis, MN, USA.
J Viral Hepat. 2021 Jul;28(7):1091-1097. doi: 10.1111/jvh.13519. Epub 2021 May 3.
Some studies have exposed an increase in liver cirrhosis in hepatitis E seropositive individuals living with human immunodeficiency virus. The interrelation between HEV seroprevalence and risk of liver disease in immune-competent individuals remains under- investigated. Using the National Health and Nutrition Examination Survey (NHANES) data containing >30,000 subjects, we addressed if HEV exposure leads to subclinical effects that can influence liver health. We determined the association between HEV IgM and ALT and that of HEV IgG and Fib-4-a composite score reflecting potential liver fibrosis. These analyses were repeated in populations at risk for liver disease as well as among different races and ethnicities. The prevalence of HEV IgG was significantly associated with age as IgG positive individuals were, on average, 20 years older than IgG negative patients. We found a statistically significant increase in the likelihood of having a Fib-4 score >1.45 (significant fibrosis) in those positive for HEV IgG (RR: 1.03; 95% CI: 1.01-1.05). However, due to the small effect, it is unlikely that this association has clinical significance. Moreover, the effect was not present in those with pre-existing liver disease. We found no association between ALT levels and the presence of HEV IgM or IgG. This is the first study examining subclinical effects of HEV infection in the United States. Our study found that in the general US population, predominantly asymptomatic HEV infections do not contribute to the overall burden of liver disease.
一些研究表明，在感染人类免疫缺陷病毒（HIV）的肝炎 E 血清阳性个体中，肝硬化的发病率有所增加。然而，HEV 血清流行率与免疫功能正常个体肝病风险之间的关系仍未得到充分研究。本研究利用包含>30000 名受试者的全国健康和营养调查（NHANES）数据，探讨了 HEV 暴露是否会导致亚临床影响，从而影响肝脏健康。我们确定了 HEV IgM 与 ALT 之间的关联，以及 HEV IgG 与 Fib-4（一种反映潜在肝纤维化的综合评分）之间的关联。这些分析在易患肝病的人群以及不同种族和族裔中重复进行。HEV IgG 的流行率与年龄显著相关，因为 IgG 阳性个体的平均年龄比 IgG 阴性患者大 20 岁。我们发现，在 HEV IgG 阳性者中，Fib-4 评分>1.45（显著纤维化）的可能性显著增加（RR：1.03；95%CI：1.01-1.05）。然而，由于影响较小，这种关联不太可能具有临床意义。此外，这种关联在存在先前存在的肝病的患者中并不存在。我们没有发现 ALT 水平与 HEV IgM 或 IgG 存在之间的关联。这是首次在美国研究 HEV 感染的亚临床影响。我们的研究发现，在普通美国人群中，主要是无症状的 HEV 感染不会导致肝脏疾病的总体负担增加。
