Autoimmune liver disease-associated serologic profiling in Chinese patients with acute hepatitis E virus infection

Abstract

The association between hepatitis E virus (HEV) and autoimmune liver diseases has been well-researched; however, the focus has been on autoimmune hepatitis (AIH) and not primary biliary cholangitis (PBC). Therefore, we aimed to investigate the prevalence and evolution of AIH- and PBC-related autoantibodies in Chinese patients with HEV infection. In this retrospective study, 164 patients with acute HEV were included, specifically those whose liver autoantibody results were available and who had no pre-existing liver disease at the time of HEV diagnosis. Positive liver autoimmune serology was present in 69 (42.1%) patients and 21 (12.8%) had at least two autoantibodies at diagnosis. Greater age and alkaline phosphatase levels were independent risk factors for autoantibody positivity. Follow-up serologic tests, which were available for 27 of the 69 autoantibody-positive patients, showed that although antinuclear antibodies disappeared in 11/20 (55.0%) and antimitochondrial antibodies disappeared in 4/5 (80%) patients, 16 still remained positive for autoantibodies and two of them even developed new PBC-related antibodies, as described below. One patient developed a rim-like ANA pattern, accompanied by an enhancement of anti-gp210 positivity; and the other was diagnosed as PBC, based on chronic elevation of cholestatic enzymes and presentation with de novo AMA-M2, 18 months after HEV clearance. In conclusion, AIH- and PBC-related autoantibodies are frequently present during acute HEV infection, indicating that HEV should be excluded before diagnosing AIH and/or PBC. Importantly, some cases maintained or developed autoantibodies after viral clearance, and one patient subsequently developed PBC, highlighting that these individuals warrant long-term follow-up.

Acute Hepatitis E Virus Infection Triggering Autoimmune Hepatitis in a Patient With Chronic Liver Disease: Case Report and the Review of the Literature

“…HEV is classically associated with circulating liver-directed autoantibodies. Reports by Gui et al found that following acute HEV, 7.7% of patients may have circulating anti-mitochondrial antibody (AMA) or ANA [ 9 ]. Another study by Piccoli et al [ 9 ] found that acute HEV infection may present with circulating autoantibodies.…”

“…Reports by Gui et al found that following acute HEV, 7.7% of patients may have circulating anti-mitochondrial antibody (AMA) or ANA [ 9 ]. Another study by Piccoli et al [ 9 ] found that acute HEV infection may present with circulating autoantibodies. Among 48 patients with acute viral hepatitis half of them had circulating liver-directed autoantibodies.…”

Expression Profiles of Hepatic Immune Response Genes in HEV Infection

“…Additionally, the virus may worsen preexisting liver abnormalities, which can lead to a more rapid development of liver disease as well as an increased risk of liver failure. The acute liver failure that may result from an HEV infection in certain people is a condition that poses a significant risk to their lives [ 27 , 28 ].…”

The future risk of primary biliary cholangitis (PBC) is low among patients with incidental anti‐mitochondrial antibodies but without baseline PBC

“…Finally, we found that AMA was also detectable in patients with other autoimmune diseases, which was consistent with previous reports. [ 21 , 22 , 23 , 24 , 25 ] Of note, like in many medical centers in China, in our institute AMA is included in the panel of ANA testing and routinely ordered for patients with suspected rheumatologic disorders, or patients with fever of unknown origin from various departments, especially from rheumatology department. This may partially explain the relatively high proportion of patients with autoimmune diseases in AMA‐positive patients in the current study.…”