Clinical Scorecard: Elevated Seroprevalence of Hepatitis E Virus in Individuals with Hepatitis B and Unexplained Hepatitis Cases in Central Vietnam

At a Glance

Key Highlights

• Anti-HEV IgG seroprevalence was 26% in HBV patients and 36% in patients with hepatitis of unknown etiology.
• Highest HEV seroprevalence (46%) observed in HBV patients with liver cirrhosis and hepatocellular carcinoma.
• No HEV RNA detected and only 0.1% tested positive for anti-HEV IgM, indicating low active HEV infection prevalence.

Guideline-Based Recommendations

Diagnosis

• Use enzyme-linked immunosorbent assay (ELISA) to detect anti-HEV IgG and IgM antibodies.
• Confirm active HEV infection by reverse transcriptase-polymerase chain reaction (RT-PCR) for HEV RNA.
• Quantify HBV viral load using real-time PCR in co-infected patients.

Management

• Monitor patients with chronic liver disease for HEV exposure, especially those with HBV co-infection.
• Recognize that HEV exposure is common but not clearly associated with liver disease progression in this population.
• No specific antiviral treatment for HEV infection indicated given low active infection rates.

Monitoring & Follow-up

• Regular biochemical liver function tests in patients with chronic liver disease regardless of HEV serostatus.
• Surveillance for clinical signs of liver disease progression in HBV patients with or without HEV exposure.

Risks

• HEV infection poses increased risk in high-risk groups such as pregnant women, organ transplant recipients, and immunocompromised patients.
• Co-infection with HEV and HBV may exacerbate liver pathology, though this study found no significant association with disease progression.
• Poor sanitation and zoonotic exposure (e.g., pig contact) increase HEV transmission risk.

Patient & Prescribing Data

Patients with chronic liver disease including HBV infection and hepatitis of unknown etiology in Central Vietnam

HEV exposure is common but active infection is rare; management focuses on monitoring liver disease rather than specific HEV antiviral therapy.

Clinical Best Practices

• Incorporate HEV serological testing in the evaluation of patients with chronic liver disease and unexplained hepatitis.
• Maintain high standards of sanitation and food safety to reduce HEV transmission risk.
• Educate patients about zoonotic transmission risks, especially in regions with high pig farming activity.
• Consider HEV exposure history when assessing liver disease etiology but recognize it may not drive disease progression.

References

• World Health Organization Hepatitis E Fact Sheet
• HEV Genotypes and Epidemiology
• HEV and HBV Co-infection Clinical Impact
• HEV Seroprevalence in Southeast Asia
• Vietnam Hepatitis B Epidemiology