Superinfection of hepatitis E Virus as a cause of decompensation in liver cirrhosis due to hepatitis B virus

Objevtive:Super infection with hepatitis A virus(HAV ) and hepatitis E virus(HEV ) in the presence of underlying hepatocellular injury can cause severe illness.In endemic areas such as India,however most patients already have been exposed to HAV but could still be susceptible to HEV infection.In our study we determined the seroprevalence of anti-HAV IgM and anti-HEV IgM to assess the incidence of superinfection with these viruses in cirrhotic patients with the goal of defining the need for protection against these viruses and further correlate the presence of these viruses with the clinical course.Methods:We studied 53 patients of cirrhosis as a result of Hepatitis B virus.Apparent causes of decompensation were ruled out before their inclusion in the study group.Serum sample from these patients was tested for HBsAg,anti HBc IgG,anti HEV IgM and anti HAV IgG and IgM by commercially available ELISA kit.Liver function test was done on all the patients and correlated with various serological markers.Results:anti HBc IgG was present in all the cases of cirrhosis. Hepatitis B surface antigen was present in 20 out of 53 cases of cirrhosis.None of the patients demonstrated anti-HAV IgM,however one patient had anti-HEV IgM.Conclusion:Superinfection with HAV in adult patient is uncommon in India.Prevalence of acute HEV infection in decompensated cirrhosis is low in the present study but presence of HEV superinfection in one patient corroborates the apprehension of liver function deterioration following superinfection with HEV virus.