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

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

Chandraetal.VirologyJournal2010,7:213 /content/7/1/213 RESEARCH OpenAccess DynamicsofHEVviremia,fecalsheddingandits relationshipwithtransaminasesandantibody responseinpatientswithsporadicacutehepatitisE NidhiSChandra1,2*,AshaSharma,BhartiMalhotra ,RameshRRai1 2 3 Abstract Background:Thereispaucityofdataregardingdurationoffecalexcretionandviremiaonsequentialsamples fromindividualpatientsanditscorrelationwithserumtransaminasesandantibodyresponsesinpatientswith acutehepatitisE.ThisprospectivestudywasundertakenatatertiarycarecenterinNorthernIndiaover15months. OnlythosepatientsofsporadicacutehepatitisEwhowereintheirfirstweekofillnessandfollowedupweeklyfor liverfunctiontests,IgMantiHEVantibodyandHEVRNAinseraandstoolwereincluded.HEVRNAwasdonebyRT -nPCRusingtwopairsofprimersfromRdRpregionofORF1oftheHEVgenome. Results:Overaperiodof15months60patientsmettheinclusioncriterionandwereenrolledforthefinal analysis.Themeanageofthepatientswas29.2±8.92years,therewere39males.ThepositivityofIgMantiHEV was80%atdiagnosisand18.3%at7thweek,HEVRNA85%atdiagnosisand6.6%at7thweekandfecalRNA70% atthetimeofdiagnosisand20%at4thweek.Themaximumdurationofviremiadetectedwas42daysandfecal viralsheddingwas28daysaftertheonsetofillness. Conclusion:PresentstudyreportedHEVRNApositivityinseraafternormalizationoftransaminases.Fecalshedding wasnotseenbeyondnormalizationoftransaminases.However,viremialastedbeyondnormalizationof transaminasessuggestingthatliverinjuryisindependentofviralreplication. Background understandingpathogenesis andtransmissiondynamics Hepatitis E virus is the etiological agent of non-HAV of acute hepatitis E. The information is either from a enterically transmitted hepatitis and major cause of humanvolunteer whoingested HEV [7] orastudy [8], sporadic as well as epidemic hepatitis [1,2]. In Indian based predominantly on pooled data of single sample subcontinent,itaccountsfor30-60%ofsporadichepati- fromdifferent patientsduringHEVepidemics. Dataon tis [3,4]. One distinct feat