Dynamics of HEV viremia, fecal shedding and its relationship with transaminases and antibody response in patients with sporadic acute hepatitis E

Over a period of 15 months 60 patients met the inclusion criterion and were enrolled for the final analysis. The mean age of the patients was 29.2 ± 8.92 years, there were 39 males. The positivity of IgM anti HEV was 80% at diagnosis and 18.3% at 7th week, HEV RNA 85% at diagnosis and 6.6% at 7th week and fecal RNA 70% at the time of diagnosis and 20% at 4th week. The maximum duration of viremia detected was 42 days and fecal viral shedding was 28 days after the onset of illness.Present study reported HEV RNA positivity in sera after normalization of transaminases. Fecal shedding was not seen beyond normalization of transaminases. However, viremia lasted beyond normalization of transaminases suggesting that liver injury is independent of viral replication.Hepatitis E virus is the etiological agent of non-HAV enterically transmitted hepatitis and major cause of sporadic as well as epidemic hepatitis [1,2]. In Indian subcontinent, it accounts for 30-60% of sporadic hepatitis [3,4]. One distinct feature of hepatitis E, compared with other forms of viral hepatitis is its higher incidence and severity in pregnant woman [5]. The overall mortality rate of hepatitis E is generally lower than 1% but it can be as high as 20-25% among pregnant women [6].Being a disease of developing countries a fair amount of information has been generated from India. There is paucity of data regarding duration of fecal excretion and viremia on sequential multiple samples from individual patients and its relationship with serum transaminases and IgM antibody response. This information is vital for understanding pathogenesis and transmission dynamics of acute hepatitis E. The information is either from a human volunteer who ingested HEV [7] or a study [8], based predominantly on pooled data of single sample from different patients during HEV epidemics. Data on sequential samples obtained from individual patients is scant.Two studies with relatively less number of patients have looked for viremi