Study Highlights Need for Routine Hepatitis E Testing in Cirrhosis

For patients with preexisting liver damage, however, infection can trigger rapid deterioration and is often overlooked in clinical workflows. Standard diagnostics may also miss cases once circulating viral RNA has waned, complicating recognition and timely care. New findings demonstrate the scale of this risk and highlight key laboratory considerations for patients with liver cirrhosis.

At Hannover Medical School (MHH), investigators examined how laboratory detection of hepatitis E virus (HEV) can inform care for patients with liver cirrhosis and emphasized the need for routine testing. The team noted that HEV infections are common, with more than 2 million cases annually in Europe and up to 400,000 in Germany, often linked to contaminated pork, yet they remain frequently underdiagnosed. The authors urged greater clinical vigilance and broader access to HEV assays to enable timely antiviral management.

The approach centered on two complementary modalities available to clinical laboratories: blood testing for HEV RNA and serologic assessment for virus-specific antibodies. Importantly, a negative RNA result does not exclude recent infection because some patients present after viremia has subsided, even as liver injury is already evident. In a separate immune-status analysis, only one third of evaluated patients demonstrated an HEV-specific antibody response, indicating substantial susceptibility in advanced cirrhosis.

The study analyzed 249 blood samples from inpatients with cirrhosis at MHH to assess the clinical course associated with HEV infection. Approximately half of infected patients developed acute-on-chronic liver failure (ACLF), a severe complication; among that subgroup, about half died or required liver transplantation. The researchers also noted episodes of acute liver decompensation, reinforcing the need for systematic HEV testing in this population.

Findings were published in Liver International in 2026. In related research at MHH and TWINCORE, neutralizing antibodies derived from convalescent donors were identified as a potential preventive and therapeutic strategy for severe HEV, although further development is required before clinical use. While no virus-specific drugs are approved, chronic infections can be treated with ribavirin, underscoring the value of precise virologic and serologic diagnosis.

“Our observations suggest that HEV can trigger clinical deterioration in patients with liver cirrhosis. At the MHH, we are therefore keeping a close eye on HEV and, where an infection is suspected, we test the blood for viral RNA,” said Dr. Katja Dinkelborg, Ph.D., lead author of the study.

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