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Abstract

Hepatitis E virus (HEV) is the most common cause of enteral non-A, non-B hepatitis. Alcohol abuse, concomitant liver diseases and immunosuppression are thought to increase the risk of contagion, severe illness, and development of chronic disease. HEV infection might take a severe course in those coinfected with other hepatotropic viruses.

Objectives: The aim of this paper is to present a retrospective analysis of the clinical course and outcome of acute hepatitis E infection in patients with confirmed chronic hepatitis B and C infection, who were treated at the Department of Infectious Diseases of Pazardzhik Multiprofile Hospital for Active Treatment, Pazardzhik, Bulgaria between 2013– 2017.

Materials and Methods: 25 patients, 22 males and 3 females, with acute hepatitis E infection and concomitant chronic hepatitis B and C infection. The methods used include epidemiological study, clinical observation, laboratory, and serological tests for detection of viral antigens and antibodies, and medical imaging (abdominal ultrasonography). The diagnosis of acute hepatitis E was established by the detection of specific anti-HEV IgM, IgG antibodies in significantly high values; chronic HBV and HCV infection was confirmed by the detection of viral antigens and specific antibodies.

Results: Chronic HBV infection was found in 18 of the patients (72%), 6/25 (24%) were with chronic hepatitis C, whereas only 1 (4%) had chronic HBV/HCV coinfection. 40% had cardiovascular disease and/or diabetes, 7 had cirrhosis. Alcohol abuse was reported by 7 patients. Complication due to acute on chronic liver failure was observed in 4 patients, 2 of whom died. The disease end in recovery in 23 patients.

Conclusion: People with pre-existing liver diseases, including chronic viral hepatitis, are at increased risk of severe hepatitis E and unfavorable outcome. Further studies among larger group that include people from risk groups and the general population would contribute to the better understanding of hepatitis E infection.