Hepatitis E Virus Infection as a Trigger of Hepatic Decompensation: A Single-Center Prospective and Cross-Sectional...

Hepatitis E virus (HEV) is a recognized cause of acute hepatitis and a potential trigger of acute decompensation (AD) and acute-on-chronic liver failure (ACLF) in patients with cirrhosis in hyperendemic regions; however, its clinical relevance in low-endemic settings remains poorly defined. We conducted a combined cross-sectional and prospective longitudinal study to evaluate the prevalence and clinical impact of HEV infection among patients with cirrhosis in Argentina. Adult patients with mild-to-moderate cirrhosis (Child-Pugh score 6-12) of different etiologies were tested for anti-HEV IgG and IgM antibodies by ELISA and HEV RNA by RT-PCR in serum samples. Epidemiological data were collected using a structured questionnaire. In the longitudinal cohort, patients were followed for up to 24 months with serial sampling at baseline, every 6 months, and during episodes of hepatic decompensation. Anti-HEV IgG seroprevalence was 5.2% (95% CI: 2.2-11.5%), comparable to that observed in healthy blood donors, with no significant differences across cirrhosis etiologies. No patient had detectable anti-HEV IgM or HEV RNA at baseline. During follow-up, 19 patients developed hepatic decompensation, including six cases of ACLF; three patients showed anti-HEV IgG positivity, including one seroconversion, but none had evidence of acute HEV infection. These findings indicate limited HEV exposure among patients with cirrhosis in this low-endemic region and suggest that HEV infection is unlikely to represent a major trigger of AD or ACLF, although continued surveillance remains warranted.