Abstract
BackgroundHepatitis E virus (HEV) infection takes a clinically silent, self-limited course in the far majority of cases. Chronic hepatitis E has been reported in some cohorts of immunocompromised individuals. The role of HEV infections in patients with autoimmune hepatitis (AIH) is unknown.Methods969 individuals were tested for anti-HEV antibodies (MP-diagnostics) including 208 patients with AIH, 537 healthy controls, 114 patients with another autoimmune disease, rheumatoid arthritis (RA), and 109 patients with chronic HCV- or HBV-infection (HBV/HCV). Patients with AIH, RA and HBV/HCV were tested for HEV RNA. HEV-specific proliferative T cell responses were investigated using CFSE staining and in vitro stimulation of PBMC with overlapping HEV peptides.ResultsHEV-antibodies tested more frequently positive in patients with AIH (n = 16; 7.7%) than in healthy controls (n = 11; 2.0%; p = 0.0002), patients with RA (n = 4; 3.5%; p = 0.13) or patients with HBV/HCV infection (n = 2; 2.8%; p = 0.03). HEV-specific T cell responses could be detected in all anti-HEV-positive AIH patients. One AIH patient receiving immunosuppression with cyclosporin and prednisolone and elevated ALT levels had acute hepatitis E but HEV viremia resolved after reducing immunosuppressive medication. None of the RA or HBV/HCV patients tested HEV RNA positive.ConclusionsPatients with autoimmune hepatitis but not RA or HBV/HCV patients are more likely to test anti-HEV positive. HEV infection should been ruled out before the diagnosis of AIH is made. Testing for HEV RNA is also recommended in AIH patients not responding to immunosuppressive therapy.
Highlights
Autoimmune hepatitis (AIH) is an immune mediated liver disease more often affecting women than men
The aims of this study were (i) to investigate the prevalence of antibodies to Hepatitis E virus (HEV) in patients with autoimmune hepatitis and (ii) to determine if AIH patients receiving standard immunosuppressive medications are at risk for chronic hepatitis E in a low endemic Central European country and (iii) to rule out that rare cases of immunocompetent patients with chronic HEV infection had been misdiagnosed as autoimmune hepatitis
Prevalence of HEV antibodies in patients with autoimmune hepatitis or persistent HBV- or hepatitis C virus (HCV)-infections
Summary
Autoimmune hepatitis (AIH) is an immune mediated liver disease more often affecting women than men. AIH is characterised by elevated serum IgG levels, the presence of certain autoantibodies and distinct histological features in the absence of other causes of liver disease [1]. Already 20 years ago an association between herpes simplex virus 1 (HSV 1) infection and autoimmune hepatitis has been described [2,3]. Other infectious agents including hepatitis C virus (HCV), cytomegalovirus, human T lymphotropic viruses 1 and 2 or salmonella typhimurum have been suggested to induce autoimmune liver disease [4]. If infections with the hepatitis E virus (HEV) are associated with AIH is unknown. Hepatitis E virus (HEV) infection takes a clinically silent, self-limited course in the far majority of cases. The role of HEV infections in patients with autoimmune hepatitis (AIH) is unknown
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