{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:16:21Z","timestamp":1789560981956,"version":"build-2803163510"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:p>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\u2010related 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\u2010HEV immunoglobulin (Ig) M and anti\u2010HEV IgG levels. Subjects with a detectable anti\u2010HEV 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\u2010induced liver injury DILI (22%), acute hepatitis B virus infection (12%), autoimmune hepatitis (12%), and pregnancy\u2010related ALF (2%). Three men ages 36, 39, and 70 demonstrated repeatedly detectable anti\u2010HEV IgM, but all were HEV\u2010RNA negative and had other putative diagnoses. The latter 2 subjects died within 3 and 11 days of enrollment whereas the 36\u2010year\u2010old underwent emergency liver transplantation on study day 2. At admission, 294 (43.4%) of the ALF patients were anti\u2010HEV IgG positive with the seroprevalence being highest in those from the Midwest (50%) and lowest in those from the Southeast (28%). Anti\u2010HEV IgG<jats:sup>+<\/jats:sup> subjects were significantly older, less likely to have APAP overdose, and had a lower overall 3\u2010week survival compared to anti\u2010HEV IgG<jats:sup>\u2010<\/jats:sup> subjects (63% vs. 70%; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.018). <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: 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\u2010related ALF cases. Past exposure to HEV with detectable anti\u2010HEV IgG was significantly more common in the ALF patients compared to the general U.S. population. (H<jats:sc>epatology<\/jats:sc> 2016;64:1870\u20101880)<\/jats:p>","DOI":"10.1002\/hep.28649","type":"journal-article","created":{"date-parts":[[2016,5,24]],"date-time":"2016-05-24T16:48:55Z","timestamp":1464108535000},"page":"1870-1880","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":59,"title":["The role of hepatitis E virus infection in adult Americans with acute liver failure"],"prefix":"10.1097","volume":"64","author":[{"given":"Robert John","family":"Fontana","sequence":"first","affiliation":[{"name":"Department of Internal Medicine,University of Michigan,Ann Arbor,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald E.","family":"Engle","sequence":"additional","affiliation":[{"name":"National Institute of Allergy and Infectious 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Southwestern,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Purcell","sequence":"additional","affiliation":[{"name":"National Institute of Allergy and Infectious Diseases,Bethesda,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Lee","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the US Acute Liver Failure Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,6,23]]},"reference":[{"key":"hep28649-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.jhep.2007.12.008","article-title":"Hepatitis E: an emerging awareness of an old disease","volume":"48","year":"2008","journal-title":"J 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