Thématique :
- Foie
- Hépatites virales
Originalité :
Solidité :
Très solide
Doit faire évoluer notre pratique :
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
  2016 Dec;64(6):1870-1880  
  doi: 10.1002/hep.28649  
  The role of hepatitis E virus infection in adult Americans with acute liver failure.  
  Fontana RJ, Engle RE, Scaglione S, Araya V, Shaikh O, Tillman H, Attar N, Purcell RH, Lee WM; US Acute Liver Failure Study Group  


Acute hepatitis E virus (HEV) infection is a leading cause of acute liver failure (ALF) in many developing countries, yet rarely identified in Western countries. Given that antibody testing for HEV infection is not routinely obtained, we hypothesized that HEV-related ALF might be present and unrecognized in North American ALF patients. Serum samples of 681 adults enrolled in the U.S. Acute Liver Failure Study Group were tested for anti-HEV immunoglobulin (Ig) M and anti-HEV IgG levels. Subjects with a detectable anti-HEV IgM also underwent testing for HEV RNA. Mean patient age was 41.8 years, 32.9% were male, and ALF etiologies included acetaminophen (APAP) hepatotoxicity (29%), indeterminate ALF (23%), idiosyncratic drug-induced liver injury DILI (22%), acute hepatitis B virus infection (12%), autoimmune hepatitis (12%), and pregnancy-related ALF (2%). Three men ages 36, 39, and 70 demonstrated repeatedly detectable anti-HEV IgM, but all were HEV-RNA negative and had other putative diagnoses. The latter 2 subjects died within 3 and 11 days of enrollment whereas the 36-year-old underwent emergency liver transplantation on study day 2. At admission, 294 (43.4%) of the ALF patients were anti-HEV IgG positive with the seroprevalence being highest in those from the Midwest (50%) and lowest in those from the Southeast (28%). Anti-HEV IgG+ subjects were significantly older, less likely to have APAP overdose, and had a lower overall 3-week survival compared to anti-HEV IgG- subjects (63% vs. 70%; P = 0.018).


Acute HEV infection is very rare in adult Americans with ALF (i.e., 0.4%) and could not be implicated in any indeterminate, autoimmune, or pregnancy-related ALF cases. Past exposure to HEV with detectable anti-HEV IgG was significantly more common in the ALF patients compared to the general U.S.


Question posée
Y-a-t-il des hépatites fulminantes dues au virus de l’hépatite E (VHE) aux USA?
Question posée
Oui, mais le nombre est très faible, évalué dans cette étude à 0,4% et a priori n’a pas de rôle dans les hépatites fulminantes sans cause trouvée, ni dans celles auto-immunes ou au cours de la grossesse. En revanche, les IgG anti-VHE sont trouvés à un taux significativement plus important chez les patients avec hépatite fulminante comparés à la population générale.

Cela ne doit pas faire modifier nos pratiques en France. La recherche d’une infection à VHE lors d’une hépatite fulminante doit être systématique car en Europe l’imputabilité du VHE est trouvée dans plus de 10% des cas. Cela est peut être lié au caractère plus pathogène du VHE de génotype 1.