HEV Infection in the Context of Prior HBV-Related Liver Injury: Case Series

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Olariu et al., present a manuscript reporting five clinical cases of HEV and HBV co-infection. The cases are noteworthy and provide clinical insights that may be valuable for clinical practice. The manuscript is well-written, and the discussion is adequate. However, I have some comments:

It is important to mention some limitations of the work in the discussion section. For example, the lack of confirmation of HEV infection through genetic identification. This is significant 0because tests for detecting anti-HEV antibodies have a notable degree of cross-reactivity with other infectious agents. I recommend reviewing the following references: 10.1002/jmv.23827, 10.3851/IMP2991, 10.33073/pjm-2020-025.

Regarding the discussion, you may benefit from reviewing and incorporating information from the following publications: 10.14218/JCTH.2020.00030, 10.5812/hepatmon.93840, 10.1038/s41598-020-59670-4, 10.1002/ijc.33505. Highlighting the originality of this study in comparison to other published studies would also be beneficial.

Where available, it would be advisable to include liver imaging photographs as figures in the article.

Taxonomic categories, such as Hepeviridae and Hepadnaviridae, should be italicized.

Decimal numbers should be written with periods instead of commas.

In the table, please clarify the meaning of "Not determined."

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I thank the author for their submission, which I am honored to review. To contribute to the authors in the most constructive way possible, I respectfully provide the organized commentary with constructive criticism below.

Title:

Consider listing the number of cases. Moreover, the system indicates that the title is "HEV infection in the context of prior HBV-related liver injury: Case series and mini-literature review," which does not match the title in the uploaded document.

Abstract:

Consider quantifying the number of cases discussed and making it clearer to the reader what work has been completed in the manuscript.

Introduction:

There are many affirmations in the introduction that could benefit from citations. The authors should make sure that they include citations whenever appropriate. A major effort has to be made by the authors to include a robust list of references that support their affirmations, and without that, the manuscript must not be accepted for publication.

When presenting their objective (lines 46-48), the authors should clearly state the geographical location of the cases studied.

Cases:

Between lines 49 and 50, it would be beneficial to the reader to provide a clear explanation of how and why these cases were selected.

There is an inconsistent usage of highlights (bold) in the cases, which need to be addressed.

The current "Table 1" is never mentioned directly in the text, and its caption is too brief. Authors must improve the caption explaining all codes and symbols and cite the table in the body of the manuscript.

At the end of this section, the authors have the opportunity to produce a table that summarizes the most important characteristics of each case and allows the reader to compare them side by side.

Discussion:

Paragraph 1 (lines 125–131): Methods for literature research, as well as any methodology applied to this study, should be clearly stated in a separate section and not in the discussion.

"We searched medical literature for research papers regarding HEV + HBV infection on a period of 10 years (2014-2024). The search was made using PubMed database using certain key words (hev) AND (hbv)) AND (superinfection)) AND (chronic)) AND 127 (acute)) AND (outcome)" (from line 125 to 127): This text is part of Materials and Methods, not Discussion.

"… and yielded 9 such articles (7 retrospective and 2 prospective studies)"(lines 128 and 129): This sentence is part of Results, not Discussion.

This sentence is part of Results, not Discussion.

Paragraph 2 (lines 131–136): Indicate the number of cases mentioned and the names of the two types of infection. Relying too much on context can lead to misunderstandings and make the text less fluid and harder to read.

Paragraph 3 (lines 137–147): When mentioning "some" cases (more than one), all citations should be provided.

Paragraph 4 (lines 148–156): Try to write shorter sentences in the direct other with fewer commas. The long sentences that have several components make the text hard to read and open opportunities for ambiguities.

Following paragraphs (lines 156–167): Avoid paragraphs composed of single sentences and revise the English for clarity and style. Again, shorter sentences in direct order could be created and organized to make the text more fluid and the author's point easier to understand.

The expression "resource-rich" appears a few times, including in line 170 and in the abstract, but it is never defined. The authors should clearly state what they consider to be "resource-rich."

Conclusions:

Authors should refrain from posting conclusions that go beyond the results of their manuscript. For example, the materials and methods seem to indicate that this study is unable to measure the rarity of HEV acute infection superimposed on a chronic HBV infection. However, it is also possible that this comes from the author's additional literature review and not only the cases reported. In that case, the authors must provide more clarity on the methods and results of the literature review, including the number and diversity of papers examined.

Final recommendation:

The manuscript require corrections that the authors should be able to execute in a reasonable amount of time. Furthermore, I did not detect any fatal flaws that should have impeded the publication of the manuscript (i.e., the article does not seem to have serious flaws, additional experiments are not needed, and there is no indication that the research was conducted incorrectly). Therefore, I recommend that the journal accepts this manuscript if the authors are able to response to all the comments made by me and any other reviewers.

Comments on the Quality of English Language

I have identified a number of typos and opportunities to improve clarity in the manuscript. I advise another round of English review. During that process, authors may consider writing shorter sentences in direct order.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf