Seroprevalence Of anti-HEV IgG Research Articles

Author’s Reply: Hepatitis E Virus Infection in Iranian Kidney-Transplant Patients

: Dear Editor, On behalf of all of the coauthors, I would like to thank Dr. Kamar for his interest in our study. In the letter, Dr. Kamar summarized the most important findings on hepatitis E infection in organ transplant recipients (1), most of whom have relied on the valuable contributions by of Dr. Kamar's group in France (2-4). In our study, we noted a high seroprevalence of anti-HEV IgG. Almost 30% of transplant recipients were seropositive for anti-HEV IgG (5). We also found unexplained increases in liver function tests in transplant recipients. However, there was no significant difference in serum alanine transferase (ALT) levels between anti-HEV-seropositive and -seronegative groups (5). As mentioned in the letter, serological methods have certain limitations. There are doubts regarding the diagnostic value of anti-HEV IgG serological evaluation in the diagnosis of HEV infection. In a study in Taiwan, an area in which hepatitis E is not endemic, the sensitivity of anti-HEV IgG compared with reverse-transcription PCR was 86.7% (6). Its specificity in diagnosing acute hepatitis was 92%. Lin et al. concluded that anti-HEV IgG is a good test for screening acute hepatitis E in nonendemic areas (6). Jiang et al. evaluated the quality of diagnostic ELISA kits in detecting HEV-specific IgG using HEV diagnostic reference sera from positive and negative cases, observing that the conformity of positive results exceeded 90% in all kits (7). In contrast, Zaki et al., in Egypt, an endemic area for hepatitis E, found the sensitivity of anti-HEV IgG to be very low (2.3%) (8). It appears that the diagnostic value of anti-HEV IgG serological tests in endemic areas is questionable. As emphasized by Dr. Kamar, the setting of transplant recipients in Iran requires further evaluation using more specific modalities, such as polymerase chain reaction (PCR). Studying the presence of HEV RNA, its relationship with elevated liver enzymes, and acute or chronic forms of infection in these patients is recommended.

Hepatitis E virus coinfection in patients with HIV infection

Hepatitis E virus (HEV) infection is an emerging infection in developed countries and is thought to be a porcine zoonosis. HEV can cause chronic infection and cirrhosis in the immunosuppressed, including patients with HIV infection. Little is known about HEV and HIV coinfection. The aim of the study was to document the incidence of chronic HEV coinfection in patients with HIV infection and to determine the anti-HEV seroprevalence and compare it with that of a control population. A cohort/case-control study was carried out in two teaching hospitals in southwest England. A total of 138 patients with HIV infection were tested for HEV using an immunoassay for anti-HEV immunoglobulin M (IgM) and IgG and reverse transcriptase-polymerase chain reaction (RT-PCR), and 464 control subjects were tested for anti-HEV IgG. Demographic, lifestyle and laboratory data were prospectively collected on each patient with HIV infection. The anti-HEV IgG seroprevalence in patients with HIV infection was compared with that in controls and demographic risk factors for HEV exposure were explored using logistic regression models. There was no difference in anti-HEV IgG seroprevalence between the HIV-infected patients and controls. The only risk factor predictive of anti-HEV seropositivity was the consumption of raw/undercooked pork; sexual risk factors were unrelated. No patient with HIV infection had evidence of chronic coinfection with HEV CONCLUSIONS: Anti-HEV seroprevalence is similar in controls and patients with HIV infection. Risk factor analysis suggests that HEV is unlikely to be transmitted sexually. Chronic coinfection with HEV was absent, indicating that chronic HEV/HIV coinfection is not a common problem in this cohort.

Hepatitis E Virus and Renal Transplantation

Sepehrvand et al. demonstrated a considerable seroprevalence rate of anti-HEV in Iranian kidney transplant recipients [1]. The impact of HEV infection on renal transplantation and the risk of chronic HEV infection in this group are debated-issues that I would like to discuss. Hepatitis E virus (HEV) was first discovered in New Delhi, India, in 1955 [2]. The virus is transmitted via the oral-fecal route [3]. Other possible routes of transmission include blood transfusions, drug vertical transmission, person-to-person contact, and zoonotic transmission [4][5]. The frequency of HEV transmission by non-fecal-oral routes remains unknown [2][6]. In endemic areas, exposure occurs in childhood [7][8]. In high-income countries, most cases of hepatitis E appear to be acquired locally and are not imported from endemic regions. In these areas, it likely has a zoonotic origin [9]. In immunocompetent individuals, hepatitis E is a self-limited disease. However, HEV can cause chronic infection in solid organ transplants [10][11], patients who receive chemotherapy [12], and HIV-infected persons [13]. HEV infection causes chronic hepatitis in more than 60% of recipients of solid organ transplants. Factors that increase the risk of chronic hepatitis in solid organ transplant recipients are shorter interval since the transplant, lower levels of liver enzymes and serum creatinine, lower platelet counts, and tacrolimus-based immunosuppression (compared with cyclosporin A), the most significant of which are tacrolimus use and low platelet count [11][14][15]. In otherwise healthy kidney transplant recipients, HEV might be considered the etiological agent for the development of hepatitis in those who live in endemic regions [16]. Viral hepatitis E may progress rapidly to cirrhosis in renal transplant recipients [17]. Although occult infection of HEV may be transferred to the recipient via liver graft [18], other allograft organs appear to be clear for transmission of the virus. As a result, screening for HEV at the time of transplantation is only recommended in liver transplant donors and recipients in endemic areas [19]. Such a screen is not recommended for patients with renal failure who are waiting for renal transplantation. Rising liver enzyme levels is a nonspecific finding following solid organ transplantation. Renal transplant patients may experience such increases, due primarily to drug reactions, sepsis, and hepatotropic virus-related infectious diseases. The diagnosis of viral hepatitis E in renal transplant recipients is usually made by ELISA. In renal transplant recipients, the seroprevalence of anti-HEV IgG is 6% to 16% [10]. Other immunocompromised hosts, such as patients with hematological malignancies, might avoid forming HEV IgG following an infection. Moreover, viremia may exist for more than 6 months after an acute infection [20]. In addition, the development of HEV IgG in renal transplant patients does not appear to be universal. The presentation of chronic hepatitis in renal transplant patients may be associated with normal liver enzymes and a negative serological assay [21]. This phenomenon underscores the need for molecular studies in suspected subjects. Decreasing the numbers and doses of immunosuppressive drugs remains the first approach toward controlling viral hepatitis E in renal transplant recipients. A prolonged follow-up period might be required to assess the eventual outcome [14]. In addition, pegylated interferon alpha-2b may be useful in the management of chronic HEV infections in solid organ recipients in whom a reduction of the immunosuppressive regimen is insufficient [22]. Interestingly, 3-month Peg- IFN-α-2a therapy was shown to be efficacious in a hemodialysis patient with chronic HEV infection following renal transplantation [23]. In 2010, the efficacy of ribavirin 12 mg/kg of body weight daily for 12 weeks was reported in kidney transplant patients with chronic HEV infection. However, due to the short term follow-up (3 months), eradication of the virus could not be claimed [24]. In 2011, another report demonstrated that a 3-month course of oral ribavirin (17 mg/kg/day) in solid organ transplant patients with chronic HEV infection induced a sustained virological response for more than 4 months after cessation of ribavirin [25]. A long follow-up is always required to evaluate the outcome of HEV infection in solid organ transplant patients. HEV infection may cause cirrhosis in renal transplant individuals. As a result, close follow-up is required after the diagnosis. In addition, HEV infection may result in nonhepatic complications in kidney transplant recipients. Neurological diseases that affect the peripheral or central nervous system have been demonstrated in renal transplants with chronic HEV infection. Surprisingly, HEV was isolated from the cerebrospinal fluid in such patients [26].

Seroprevalence of Hepatitis E among Iranian Renal Transplant Recipients

Renal transplant recipients are known to be susceptible to viral infections, with more severe clinical presentations compared to healthy persons. Hepatitis E is generally a self-limited disease, which is caused by hepatitis E virus. Recently, hepatitis E has become more important in organ transplant recipients, because of new findings regarding the potential for chronic infections in this patient group. This study aimed to evaluate the seroprevalence of anti-HEV IgG among kidney transplant recipients in Urmia, in the north-western region of Iran. 91 patients were selected randomly from amongst patients who had undergone kidney transplantation in Urmia, Iran. Each patient was tested for the presence of anti-HEV IgG antibody using an enzyme-linked immunosorbent assay (ELISA, Dia.Pro; Diagnostic Bioprobes, Italy). 28 subjects (30.8%) were seropositive for anti-HEV IgG. Seropositive patients were generally older than seronegative patients (P = 0.009). There was no correlation between HEV infection and the level of education (P = 0.206), the history of blood transfusion (P = 0.164), or history of pre-transplantation hemodialysis (P = 0.228). There was no significant difference in the serum alanine aminotransferase (ALT) levels of the anti-HEV seropositive and seronegative patients. Multinomial logistic regression analysis indicated no significant relationship between HEV infection and increase in ALT levels, even after controlling for treatment with azathioprine (P = 0.79, OR = 1.12; 95% CI: 0.45-2.76). The anti-HEV IgG antibody has a high prevalence in Iranian kidney transplant recipients, and it is significantly higher in comparison with previous studies in the general population or in hemodialysis patients.

Seroprevalence of subclinical HEV infection in asymptomatic, apparently healthy, pregnant women in Dakahlya Governorate, Egypt

Background and Aim:Hepatitis E virus (HEV) is a major public health problem in the developing countries. HEV infection in pregnant women is more common and fatal in the third trimester. The present study was designed to determine the seroprevalence of subclinical HEV infection in asymptomatic pregnant women.Materials and Methods:A total of 116 asymptomatic pregnant women divided into 2 groups: Group 1 included 56 pregnant women with HCV positive serology and group 2 included 60 pregnant women with negative HCV serology were included in this study. Prevalence of anti-HEV antibodies and anti-HCV were determined by an enzyme linked immunosorbent assay (ELISA) kit.Results:The overall prevalence of anti-HEV IgG was highly significant among pregnant women with chronic HCV infection 40/56 (71.42%) than pregnant women free from chronic HCV infection 28/60 (46.7%) (P = 0.006). Chronic HCV infection in pregnant women appeared to be a risk factor associated with HEV IgG seropositivity (OR = 2.86, CI = 1.24-6.6). The seropositivity of anti-HEV IgG was significantly high in rural areas than urban areas (62.5% vs. 37.5%) in group 1 and (78.58% vs. 21.42%) in group 2 (P = 0.15) and OR = 2.2, CI = 0.65-7.7). A decrease in albumin level (P = 0.047) and an increase in bilirubin (P = 0.025), ALT (P = 0.032), and AST (P = 0.044) in pregnant women with positive HCV and IgG anti-HEV than the second group with negative HCV serology.Conclusions:The seroprevalence of anti-HEV IgG in pregnant women is high in Egypt especially in rural areas. With chronic HCV coinfection, a marked increase in anti-HEV IgG seropositivity and significant worsening of the biochemical liver indices were noted. Increased public awareness about the sound hygienic measures for a less prevalence of HEV is strongly advised. The need for HEV vaccination for those at risk, especially pregnant ladies, should be considered.

P79 Hepatitis E virus is highly endemic in South West France

IntroductionLocally acquired hepatitis E virus (HEV) infection is an emerging infection in developed countries. South West France has a high incidence of HEV and has reported a large number of...

Seroprevalence and distribution of hepatitis E virus in various ethnic groups in Gansu province, China

Gansu province is located in northwestern China and is home to 45 ethnic groups including Han, Hui, Zang and others. Different ethnic groups have varying involvement with livestock and meat consumption, especially pork. To investigate the prevalence of hepatitis E virus (HEV) infection and the distribution of HEV genotypes among the major ethnic groups in Gansu province, 2090 serum samples were collected from individuals from four regions and three ethnic groups, the Han, Hui and Zang. All serum samples were tested for anti-HEV IgG and IgM antibodies, as well as HEV antigen, and selected samples were then tested for HEV RNA. The data showed that the seroprevalence of anti-HEV IgG in the Hui, Han and Zang ethnic groups from the four regions was 8.9%, 18.7% and 32.9%, respectively, and these differed significantly ( P < 0.05). The seroprevalence of anti-HEV antibody for each ethnic group varied among the different regions. In general, within the same region, the three ethnic groups also show differences. Genomic analysis indicated that HEV isolated from humans belonged to genotype 4, and resembled closely swine HEV isolates from Gansu province. The seroprevalence of anti-HEV antibodies was in accordance with the amount of contact with pigs in the different regions. Pigs are the primary host for HEV, so people in frequent contact with pigs may be at risk of zoonotic infection. However, populations that have rare contact with pigs are more likely to be susceptible to HEV when exposed, suggesting that should be the target of vaccination.

A comparison of two commercially available anti‐HEV IgG kits and a re‐evaluation of anti‐HEV IgG seroprevalence data in developed countries

In developed countries, the incidence of hepatitis E virus (HEV) infection and the resulting seroprevalence are uncertain. Published estimates of seroprevalnce in these populations range from 0.26% to 31%, which may in part reflect the variety of assays used by different studies. This study compared the performance of two commercial assays (Genelabs [Singapore] and Wantai 'Beijing, China' HEV IgG EIA kits) and reviewed published estimates of anti-HEV seroprevalence in developed countries. The assays were compared using the WHO anti-HEV reference serum, sera from UK-acquired cases of genotype 3 HEV infections and 500 UK blood donor sera. The PE2 assay was found to be more sensitive than the GL assay (lower limit of detection for HEV IgG 0.25 vs. 2.5 WHO units/ml); it was positive in more sera from proven cases (98% vs. 56%), remained positive for longer post infection and resulted in a substantially higher estimate of seroprevalence in blood donors (16.2% vs. 3.6%). these results suggest that published studies of HEV seroprevalence using the GL assay have underestimated the true figure and that a properly validated method is required to make meaningful comparisons of HEV seroprevalence between populations.

Editorial Commentary:The Mystery of Hepatitis E Seroprevalence in Developed Countries: Is There Subclinical Infection due to Hepatitis E Virus?

<i>Editorial Commentary:</i>The Mystery of Hepatitis E Seroprevalence in Developed Countries: Is There Subclinical Infection due to Hepatitis E Virus?

Acute hepatitis E in Catania (eastern Sicily) 1980-1994. The role of hepatitis E virus.

Between 1980 and 1994, 540 patients with acute viral hepatitis were admitted to hospital at the Department of Infectious Diseases of Catania (eastern Sicily). Twenty-five patients out of 540 were assessed as having non-A, non-B, non-C hepatitis. These subjects were studied for anti-HEV IgM and IgG seroprevalence by testing serial serum samples collected 1, 4, 12 and 24 weeks after the onset of acute disease. Fourteen of 25 samples (56%) seroconverted to anti-HEV IgG antibodies. No sample was positive for anti-HEV IgG at week 1, ten samples were positive at week 4 and the remainder at week 12. Anti-HEV reactivity was maintained until week 24 in all cases. In 11 of the 14 patients seroconverting to anti-HEV, the presence of IgM anti-HEV was found, which appeared in the sample from week 1 and gradually disappeared thereafter. Identified risk factors for HEV transmission included travel in the tropics and shellfish ingestion (anti-HEV positive versus anti-HEV negative: p < 0.05). HEV-related hepatitis is not yet a major public health problem in Sicily but, from our data, the trend of its incidence is clearly upwards. The high incidence of faecally-orally transmitted diseases in Sicily, the crucial position of Sicily in the middle of the Mediterranean Sea (where HEV largely circulates) and the increase of migration from developing countries are all factors which should increase awareness for a more active surveillance of the spread of HEV in our area.