HEV prevalence, risk factors and outcomes in a tertiary care hospital of Uttar Pradesh: a retrospective observational study

Abstract

Background and Objectives: Acute hepatitis is characterized by inflammation of the liver parenchyma or hepatocellular injury, leading to impaired liver function. Hepatitis E virus (HEV) is a major cause of acute viral hepatitis in Asia, including India. This study aimed to investigate the various etiologies of viral hepatitis and analyse the demographic profile and clinical outcomes of HEV infection.
Materials and Methods: This retrospective observational study was conducted at the VRDL, Department of Microbiology, JNMCH, Aligarh, and included 1,168 patients presenting with deranged liver function tests and clinical signs of hepatitis between August 2022 and March 2024. Serum samples were tested for HAV (IgM), HBV (HBsAg), HCV (IgM and IgG), and HEV (IgM) using ELISA (Dia Pro, Italy). HEV IgM-positive patients were followed up using a predesigned proforma to assess clinical outcomes and their association with demographic factors.
Results: Out of 1,168 samples screened for viral hepatitis markers, 753 (64%) tested positive for Hepatitis A, B, C, or E. HAV was the most common (554 cases, 73.5%), followed by HEV (125 cases, 16.6%). These HEV IgM positive samples were further subjected to RT-PCR, and 34 were positive and 91 negative among them. Most HEV-positive cases were aged 16-30 years, with a mean age of 19.3 ± 12.1 years. A history of consuming unfiltered water was reported in 78% of HEV cases. The highest number of HEV cases were from Jeevangarh (21.6%) and Jamalpur (14.4%), followed by Dodhpur (8.8%) and Nagla Mohalla (8%). Fever (96%) was the most common symptom, followed by jaundice (86%) and abdominal pain (84%). Key risk factors included residing in rural or semi-urban areas, use of public toilets, and overcrowding. Among the 125 HEV IgM-positive patients, only two fatalities were reported; the remaining recovered within 3 to 6 months.
Conclusion: HEV is a major cause of acute hepatitis in our region, with sporadic cases year-round and outbreaks peaking during the monsoon and post-monsoon seasons. Most cases originated from areas with poor sanitation and hygiene.