Abstract
Hepatitis E virus (HEV) is an important cause of hepatitis, which can be transmitted via the bloodborne route. However, risk of hepatitis E among persons who inject drugs (PWIDs) is poorly understood. This study aimed to elucidate whether PWIDs are at risk for hepatitis E. We performed HEV IgM, IgG and nucleic acid detection on a cohort of 91 PWIDs and 91 age- and sex-matched organ donors. Blood HEV IgG was measured using the WHO HEV antibody standard. The effects of age, gender and addictive injection use on HEV serostatus and concentration were assessed. HEV IgG seroprevalence was 42/91 (46.2%) in the PWID group and 20/91 (22%) in the donor group (odds ratio = 3.04 (1.59–5.79), p = 0.0006). The median HEV IgG concentration was 5.8 U/mL (IQR: 2.5–7.9) in the PWID group and 2.1 U/mL (IQR: 1.2–5.3) in the donor group (p = 0.005). Increasing age and addictive injection use were significantly associated with HEV IgG serostatus, but only addictive injection use was associated with HEV IgG concentration (p = 0.024). We conclude that PWIDs are at increased risk for hepatitis E and are prone to repeated HEV exposure and reinfection as indicated by higher HEV IgG concentrations.
Highlights
Hepatitis E virus (HEV) is an important cause of viral hepatitis globally [1]
We investigated the association between addictive injection use and hepatitis E by conducting a matched cohort study among persons who inject drugs (PWIDs) and organ donors in Hong Kong, a HEV-A genotype 4 endemic area with a population HEV seroprevalence of 15.8% [25,26]
We evaluated hepatitis C virus (HCV)-infected PWIDs because this is an indicator of high-risk practices such as needle sharing [27,28], which in turn would render these individuals at higher risk of other bloodborne infections like hepatitis E
Summary
Hepatitis E virus (HEV) is an important cause of viral hepatitis globally [1]. Hepatitis E is mostly caused by four genotypes within species A of the Orthohepevirus genus (HEV-A) under the family Hepeviridae [2]. We recently discovered that Orthohepevirus species C genotype 1 (HEV-C1), known as rat hepatitis E, can cause hepatitis in humans [6,7]. In addition to foodborne transmission, HEV-A genotypes 3 and 4 can be transmitted via contaminated blood products or organs [8,9]. Asymptomatic viremic blood donors have been documented in several countries [10] Such bloodborne transmission has prompted several countries to initiate HEV screening of blood and organ donors [11,12]
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