{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T17:17:35Z","timestamp":1770916655087,"version":"3.50.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Hepatitis B virus (HBV) infection poses a major global public health challenge. Recent studies have highlighted the clinical implications of coinfection with the hepatitis E virus (HEV) in HBV-infected individuals, as this dual infection is associated with exacerbated disease severity. However, epidemiological data on HBV\/HEV coinfection in the Hebei region are scarce, necessitating further investigation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a multicenter cross-sectional study for infectious diseases across six tertiary hospitals. Serum samples were screened for anti-HEV IgM and IgG antibodies by using an automated chemiluminescent immunoassay. Samples positive for anti-HEV antibodies were further subjected to HEV RNA detection using the reverse transcription polymerase chain reaction (RT-PCR). The seroprevalence of anti-HEV antibodies was 18.70% (582\/3,113).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among these, 562 cases were positive for anti-HEV IgG, 4 were positive for anti-HEV IgM, and 16 were positive for both anti-HEV IgG and IgM. HEV RNA was detected in 16 (2.75%; 582) anti-HEV-seropositive individuals. A strong positive correlation was observed between anti-HEV seroprevalence and advancing age [<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.966 in the liver cirrhosis (LC) group, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.774 in the hepatocellular carcinoma (HCC) group, and <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.508 in the chronic hepatitis B (CHB) group]. Multivariate analysis confirmed that older age was an independent risk factor for anti-HEV seropositivity (OR = 1.03, 95% CI: 1.02\u20131.04, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). HBV mono-infection patients were significantly younger than those with HBV and acute HEV coinfection patients or HBV with previous HEV infection patients (53.0 vs. 58.5 vs. 58.0 years, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). Additionally, LC and HCC were more prevalent in the HBV with previous HEV infection than in HBV mono-infection (65.98% vs. 77.27%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). Compared to HBV mono-infection patients, the activated partial thromboplastin time was significantly prolonged in both HBV and HEV acute coinfection patients and in those with HBV and previous HEV infection (32.30 s vs. 35.65 s vs. 34.46 s, <jats:italic>P<\/jats:italic> &amp;lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Our findings demonstrated an 18.70% seroprevalence of anti-HEV antibodies among chronically HBV-infected patients in the Hebei Province, with a significantly higher risk of coinfection in older individuals. HBV\/HEV coinfection may aggravate liver injury and impair coagulation. These results provide valuable insights into the epidemiology and clinical consequences of HBV\/HEV coinfection in this region.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2025.1638614","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T05:24:02Z","timestamp":1754889842000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiological and clinical impact of hepatitis E virus coinfection in chronic hepatitis B infected patients in Hebei, China"],"prefix":"10.3389","volume":"16","author":[{"given":"Yuzhu","family":"Shi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuchen","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huixia","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun","family":"Guo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumin","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianhua","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erhei","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"479","DOI":"10.3201\/eid1503.080740","article-title":"Hepatitis E virus antibodies in patients with chronic liver disease.","volume":"15","author":"Atiq","year":"2009","journal-title":"Emerg. 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