Department of Obstetrics and Gynaecology, Katutura State Hospital, Windhoek, Namibia.
Department of Health Sciences, Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands.
Liver Int. 2022 Jan;42(1):50-58. doi: 10.1111/liv.15076. Epub 2021 Oct 28.
BACKGROUND & AIMS: Namibia has been suffering from an outbreak of hepatitis E genotype 2 since 2017. As nearly half of hepatitis E-related deaths were among pregnant and postpartum women, we analysed maternal and fetal outcomes of pregnancies complicated by acute hepatitis E and assessed whether HIV-status impacted on outcome.
A retrospective cross-sectional study was performed at Windhoek Hospital Complex. Pregnant and postpartum women, admitted between 13 October 2017 and 31 May 2019 with reactive IgM for Hepatitis E, were included. Outcomes were acute liver failure (ALF), maternal death, miscarriage, intra-uterine fetal death and neonatal death. Odds ratios (OR) and 95% confidence interval (CI) were calculated.
Seventy women were included. ALF occurred in 28 (40.0%) of whom 13 died amounting to a case fatality rate of 18.6%. Sixteen women (22.9%) were HIV infected, compared to 16.8% among the general pregnant population (OR 1.47, 95% CI 0.84-2.57, P = .17). ALF occurred in 4/5 (80%) HIV infected women not adherent to antiretroviral therapy compared to 1/8 (12.5%) women adherent to antiretroviral therapy (OR 28.0, 95% CI 1.4-580.6). There were 10 miscarriages (14.3%), five intra-uterine fetal deaths (7.1%) and four neonatal deaths (5.7%).
One in five pregnant women with Hepatitis E genotype 2 died, which is comparable to genotype 1 outbreaks. Despite small numbers, HIV infected women receiving antiretroviral therapy appear to be less likely to develop ALF in contrast with HIV infected women not on treatment. As there is currently no curative treatment, this phenomenon needs to be assessed in larger cohorts.
纳米比亚自 2017 年以来一直遭受 2 型戊型肝炎爆发的困扰。由于近一半的戊型肝炎相关死亡发生在孕妇和产后妇女中，我们分析了急性戊型肝炎合并妊娠的母婴结局，并评估了 HIV 状况是否对结局有影响。
这是一项在温得和克医院综合体进行的回顾性横断面研究。纳入 2017 年 10 月 13 日至 2019 年 5 月 31 日期间因戊型肝炎 IgM 反应性而入院的孕妇和产后妇女。结局为急性肝衰竭（ALF）、孕产妇死亡、流产、宫内胎儿死亡和新生儿死亡。计算了比值比（OR）和 95%置信区间（CI）。
共纳入 70 名妇女。28 名（40.0%）发生 ALF，其中 13 名死亡，病死率为 18.6%。16 名（22.9%）妇女感染了 HIV，而一般孕妇人群中的感染率为 16.8%（OR 1.47，95%CI 0.84-2.57，P=0.17）。未接受抗逆转录病毒治疗的 5 名（80%）HIV 感染妇女发生 ALF，而接受抗逆转录病毒治疗的 8 名（12.5%）妇女发生 ALF（OR 28.0，95%CI 1.4-580.6）。有 10 例流产（14.3%）、5 例宫内胎儿死亡（7.1%）和 4 例新生儿死亡（5.7%）。
五分之一的 2 型戊型肝炎孕妇死亡，这与 1 型戊型肝炎爆发相当。尽管数量较少，但接受抗逆转录病毒治疗的 HIV 感染妇女发生 ALF 的可能性似乎低于未接受治疗的 HIV 感染妇女。由于目前尚无治愈方法，需要在更大的队列中评估这种现象。
