BACKGROUND: Fulminant hepatitis is a rare outcome of infection with hepatitis E virus. Several recent reports suggest that virus variation is an important determinant of disease progression.
AIMS: To critically examine the evidence that virus-specific factors underlie the development of fulminant hepatitis following hepatitis E virus infection.
METHODS: Published sequence information of hepatitis E virus isolates from patients with and without fulminant hepatitis was collected and analysed using statistical tests to identify associations between virus polymorphisms and disease outcome.
RESULTS: Fulminant hepatitis has been reported following infection with all four hepatitis E virus genotypes that infect humans comprising multiple phylogenetic lineages within genotypes 1, 3 and 4. Analysis of virus sequences from individuals infected from a common source did not detect any common substitutions associated with progression to fulminant hepatitis. Re-analysis of previously reported associations between virus substitutions and fulminant hepatitis suggests that these were probably the result of sampling biases.
CONCLUSIONS: Host-specific factors rather than virus genotype, variants or specific substitutions appear to be responsible for the development of fulminant hepatitis. This article is protected by copyright. All rights reserved.
- hepatitis E virus
- liver failure
- virus variation
- CHRONIC LIVER-DISEASE
- SPORADIC ACUTE