High seroprevalence of anti-Hepatitis E antibodies in Austrian patients with autoimmune hepatitis.

Abstract

Increasing numbers of autochthonous hepatitis E virus infections have been reported in Europe. Chronic infections have been shown in immune-compromised patients after solid organ transplantation. Hepatitis E virus might be a possible trigger for autoimmune hepatitis and might cause disease flares or relapses in the further course of disease. Aim of this study was to investigate the presence of hepatitis E virus antibodies and hepatitis E virus RNA, and to analyse their impact on immunosuppressive treatment in patients with autoimmune hepatitis. Sera from 92 autoimmune hepatitis patients (73/79.3% female, age: 42.2±16.3years [mean±SD]) were tested. Patients were scored according to the simplified and revised scoring systems of the International Autoimmune Hepatitis Group. The prevalence of anti- hepatitis E virus antibodies (Beijing Wantai Biological Pharmacy Enterprises Co., Ltd, Beijing, China) and hepatitis E virus RNA was determined. 19/20.7% autoimmune hepatitis patients tested positive for hepatitis E virus-IgG, which was higher than in previous reports of healthy Austrian individuals (12.4%, P=0.031); hepatitis E virus RNA was not detectable in any patient. Anti-hepatitis E virus positive patients were older (49.5±9.5 vs 40.4±17.2years [mean±SD], P=0.033) but did not differ in laboratory findings at diagnosis (AST: 14.6 [1.3-70.6] vs 9.5 [0.7-62.7]×ULN [median/range]; P=0.387, alanine aminotransferase: 18.3 [1.6-62.7] vs. 12.9 [0.8-62.6]×ULN; P=0.511; IgG: 1.4 [1.0-2.5] vs 1.3 [0.6-3.8]g/dL×ULN; P=0.278) nor in alanine aminotransferase levels after six months (0.7 [0.5-2.4] vs 1.0U/L×ULN [0.1-22.4]; P=0.077). No chronic hepatitis E virus infection was observed in our cohort of autoimmune hepatitis patients. Anti- hepatitis E virus-IgG positive patients were older and the seroprevalence was nearly twice as high as reported previously in healthy Austrian individuals, suggesting that hepatitis E virus-infection might act as trigger for the development of autoimmune hepatitis.