Hepatology International

, Volume 4, Issue 3, pp 615–620 | Cite as

Comparison of effects of hepatitis E or A viral superinfection in patients with chronic hepatitis B

  • Xiaohong ZhangEmail author
  • Weimin Ke
  • Junqiang Xie
  • Zhixin Zhao
  • Dongying Xie
  • Zhiliang Gao
Original Article



To compare the demographics, liver function, and prognosis of Chinese patients infected with chronic hepatitis B (CHB) and superinfected with hepatitis E virus (HEV) or hepatitis A virus (HAV).

Patients and methods

Among 188 patients with CHB, 136 with HEV superinfection and 52 with HAV superinfection were treated at our hospital between March 1999 and October 2007 for clinical features suggestive of acute hepatitis. The patients’ age, sex, incidence of liver failure, and mortality were recorded. The tested biochemical indices and markers of liver function included serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), prothrombin activity (PTA), and the serum levels of HBeAg, HBeAb, and HBV DNA.


There were significant differences between the age and sex distributions of the two groups (P < 0.05). More patients in the CHB + HEV group had complications (94.9 vs. 61.5%, P < 0.001), and hepatic failure (39.7 vs. 11.5%, P = 0.002). Additionally, the mortality among the CHB + HEV group was significantly higher (33.8 vs. 1.9%, P < 0.001).


The comparison of clinical outcomes revealed that patients with HBV + HEV had more advanced baseline liver disease and a poorer prognosis than those with HBV + HAV. Because there is no vaccine against HEV, patients with CHB should take appropriate precautions against superinfection with HEV, such as consumption of boiled water and well-cooked food, in regions where it is endemic.


Chronic hepatitis B Hepatic failure Hepatitis A Hepatitis E Mortality Superinfection 


  1. 1.
    Chinese Center for Disease Control and Prevention website:
  2. 2.
    Xiong LS, Cui SF, Zhou JG, Xing Y. Detection and analysis of HAV-HEV, HGV infection in patients with viral hepatitis. Zhonghua Gan Zang Bing Za Zhi 2004;12:395–396 (in Chinese, with English abstract)PubMedGoogle Scholar
  3. 3.
    Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G, Ferraro T, Concia E. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med 1998;338:286–290CrossRefPubMedGoogle Scholar
  4. 4.
    Hamid SS, Atiq M, Shehzad F, Yasmeen A, Nissa T, Salam A, Siddiqui A, Jafri W. Hepatitis E superinfection in patients with chronic liver disease. Hepatology 2002;36:474–478CrossRefPubMedGoogle Scholar
  5. 5.
    Ke WM, Li XJ, Yu LN, Lai J, Li XH, Gao ZL, Chen PJ. Etiological investigation of fatal liver failure during the course of chronic hepatitis B in southeast China. J Gastroenterol 2006;41:347–351CrossRefPubMedGoogle Scholar
  6. 6.
    Protocol of prevention and treatment in viral hepatitis. Chin J Hepatol (Chinese) 2000; 8: 324–333Google Scholar
  7. 7.
    Liang XF, Chen YS, Wang XJ, He X, Chen LJ, Wang J, Lin CY, Bai HQ, Yan J, Cui G, Yu JJ. A study on the sero-epidemiology of hepatitis B in Chinese population aged over 3-years old. Chin J Epidemiol 2005;26:655–658Google Scholar
  8. 8.
    Zhang GS, Feng FM, Li YL, Yuan JX, Shang H. A study of chronic hepatitis B infection superinfected with hepatitis E infection. Zhonghua Gan Zang Bing Za Zhi 2006;14:906–908 (in Chinese, with English abstract)PubMedGoogle Scholar
  9. 9.
    Kumar M, Sharma BC, Sarin SK. Hepatitis E virus as an etiology of acute exacerbation of previously unrecognized asymptomatic patients with hepatitis B virus-related chronic liver disease. J Gastroenterol Hepatol 2008;23:883–887CrossRefPubMedGoogle Scholar
  10. 10.
    Kumar Acharya S, Kumar Sharma P, Singh R, Kumar Mohanty S, Madan K, Kumar Jha J, Kumar Panda S. Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death. J Hepatol 2007;46:387–394CrossRefPubMedGoogle Scholar
  11. 11.
    Keefe EB. Hepatitis A and B superimposed on chronic liver disease: vaccine-preventable diseases. Trans Am Clin Climatol Assoc 2006;117:227–268Google Scholar
  12. 12.
    Xiaodan Z, Weimin K, Hong C, Ying Z, Yangsu H. Clinical disease features of sporadic hepatitis A affected by chronic infection of hepatitis B virus. Chin J Coal Ind Med 2003;6:100–101Google Scholar
  13. 13.
    Xiangming X, Hong C, Hong D, Yangsu H, Weimin K. Effect of basis on chronic infection of hepatitis B virus on clinical features of sporadic hepatitis E. Pract Prevent Med 2000;7:247–249Google Scholar
  14. 14.
    Sainokami S, Abe K, Kumagai I, Miyasaka A, Endo R, Takikawa Y. Epidemiological and clinical study of sporadic acute hepatitis E caused by indigenous strains of hepatitis E virus in Japan compared with acute hepatitis A. J Gastroenterol 2004;39:640–648CrossRefPubMedGoogle Scholar
  15. 15.
    Mahtab MA, Rahman S, Khan M, Mamun AA, Afroz S. Etiology of fulminant hepatic failure: experience from a tertiary hospitals in Bangladesh. Hepatobiliary Pancreat Dis Int 2008;7:161–164PubMedGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2010

Authors and Affiliations

  • Xiaohong Zhang
    • 1
    Email author
  • Weimin Ke
    • 1
  • Junqiang Xie
    • 1
  • Zhixin Zhao
    • 1
  • Dongying Xie
    • 1
  • Zhiliang Gao
    • 1
  1. 1.Department of Infectious DiseasesThird Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouPeople’s Republic of China

Personalised recommendations