Introduction: Acute on chronic liver failure (ACLF) characterized mainly by acute deterioration of 
underlying chronic liver disease. Hepatitis E virus (HEV) was reported as a precipitating event. Aim 
of the study: The aim of this study was to detect HEV infection in patients with acute on chronic liver 
failure. Materials & Methods: This is across sectional study conducted in Tropical department Minia 
university hospital in the period from December 2018 to December 2019. It included 30 patients with 
acute on chronic liver disorders, where blood samples were collected and HEV tested for anti-IgM 
and IgG by ELISA and then for HEV RNA by RT-PCR. Results: HEV RNA was detected in 13% of 
patients and IgG was positive in 26.7% of patients with acute on chronic liver failure. Discussion: 
HEV infection is a common cause in patients with chronic liver disease and presented with 
unexplained ACLF. Recommendation: based on the current study we recommend searching for HEV 
infection in patients with ACLF as one of our workup.