Characterising the risk of Hepatitis E virus infection in haematological malignancies: a <scp>UK</scp> prospective prevalence study

Ankcorn, Michael; Fox, Thomas A.; Ijaz, Samreen; Nicholas, Claire; Houston, Eric D.; Longair, I; Mattes, Frank; Walker, Jemma; Tedder, Richard S.; Sekhar, Mallika

doi:10.1111/bjh.15796

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…Additionally, neither transplantation history nor blood transfusion history was associated with anti-HEV positivity. The latter is in contrast to a recent study among patients with a diagnosis of haematological malignancy, showing a linear increase in anti-HEV IgG seropositivity with the number of transfusions received during a 5-year period, suggesting HEV acquisition via blood transfusion (Ankcorn et al, 2019). These deviating results may be due to differences in unknown fractions of transfusion history outside the local hospital/region.…”

Section: Discussioncontrasting

confidence: 96%

“…The HEV RNA prevalence rate was slightly higher in our Danish PERSIMUNE cohort compared with the HEV RNA prevalence rate of 0.04% found among Danish blood donors (Harritshoj et al, 2016). In the Netherlands and the UK, HEV RNA-positive fractions among patients with allo-HSCT or haematological malignancies were 2.4% and 0.13%, respectively (Versluis et al, 2013;Ankcorn et al, 2019). Additionally, 1% and 1.16% HEV RNA reactivity were detected among SOT patients (Pas et al, 2012;Ankcorn et al, 2018) compared with 0.13% and 0.04% HEV RNA reactivity among blood donors (Hogema et al, 2016;Hewitt et al, 2014).…”

Section: Discussioncontrasting

confidence: 54%

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Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients

Harritshøj

Hother

Sengeløv

et al. 2020

International Journal of Infectious Diseases

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The prevalence of active, chronic, and former hepatitis E virus (HEV) infections was investigated in a cohort of immunocompromised patients. The association with transfusion transmitted HEV was evaluated, and the HEV seroprevalence was compared with that in healthy blood donors. Study design and methods: Serum samples from 4023 immunocompromised patients at Rigshospitalet, Denmark were retrospectively tested for HEV RNA and anti-HEV IgG. HEV RNA-positive patients were followed up by HEV testing, clinical symptoms, and transfusion history. Factors associated with anti-HEV were explored by multivariable logistic regression analysis. Samples from 1226 blood donors were retrospectively tested for anti-HEV IgG. Results: HEV RNA was detected in six patients (0.15%) with no indications of chronic HEV infection. HEV RNA prevalence rates among recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT) were 0.58% and 0.21%, respectively. Transfusion transmitted infections were refuted, and transfusion history was not associated with anti-HEV positivity. The difference in HEV seroprevalence between patients (22.0%) and blood donors (10.9%) decreased when adjusting for age and sex (odds ratio 1.20, 95% confidence interval 0.97-1.48). Conclusions: HEV viremia among allo-HSCT and SOT recipients suggests that clinicians should be aware of this diagnosis. The lack of association of blood transfusion with anti-HEV positivity supports food-borne transmission as the main transmission route of HEV common to both patients and blood donors.

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Section: Discussioncontrasting

confidence: 96%

Section: Discussioncontrasting

confidence: 54%

Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients

Harritshøj

Hother

Sengeløv

et al. 2020

International Journal of Infectious Diseases

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“…Notably, although HEV infection in HIV positive patients is assumed to be strongly associated with a reduced CD4 T cell count, chronic hepatitis E may persist even after the immune system has recovered under antiretroviral therapy 6,11 . In addition to TR and HIV positive patients, chronic hepatitis E has been reported in rheumatological 12‐14 and haematological 15‐18 patients with chronification rates of up to 33%, in rheumatological patients respectively 19 . In haematological patients ongoing hepatitis E with fatal outcome was observed in 16% of patients, as recently reported 20 …”

Section: Introductionmentioning

confidence: 70%

Hepatitis E seroprevalence and viremia rate in immunocompromised patients: a systematic review and meta‐analysis

Buescher

Ozga

Lorenz

et al. 2021

Liver International

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Background and Aims Hepatitis E is an infectious disease of the liver caused by the hepatitis E virus (HEV). Immunocompromised patients present a particular risk group, as chronification of hepatitis E leading to life‐threatening cirrhosis occurs when these patients are infected. Therefore, this study aims to estimate and compare the anti‐HEV seroprevalence and the rate of HEV RNA positivity in transplant recipients and patients with human immunodeficiency virus (HIV). Methods This systematic review and meta‐analysis involved a literature search (PubMed, Scopus; 1,138 studies) including 120 studies from 1996 to 2019, reporting anti‐HEV seroprevalence and/or HEV‐RNA positivity. Statistical analysis was performed using a linear mixed‐effects meta regression model. Results Anti‐HEV seroprevalence in 14 626 transplant recipients ranged from 6% (95% CI: 1.9‐17.2) to 29.6% (95% CI: 21.6‐39.) in different commercially available assays and did not differ significantly compared to 20 825 HIV positive patients (range: 3.5% (95% CI: 0.9‐12.8) – 19.4% (95% CI: 13.5‐26.9). In contrast, HEV‐RNA positivity rate was significantly higher in transplant recipients than in HIV positive patients (1.2% (95% CI: 0.9‐1.6) vs 0.39% (95% CI: 0.2‐0.7); P‐value = 0.0011). Conclusion Anti‐HEV seroprevalence did not differ significantly between transplant recipients and HIV positive patients. Interestingly, rates of HEV‐RNA positivity, indicating ongoing infection, were significantly higher in transplant recipients. These findings demonstrate that transplant patients have an elevated risk of chronic infection in comparison to HIV patients at comparable risk of HEV‐exposure.

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“…Mohamed et al did not find HEV RNA in 27 patients with primary antibody deficiency and persistently elevated liver enzymes [29]. In addition, increased rates of acute or chronic HEV infection have not been observed in patients with relevant primary antibody deficiency such as common variable immunodeficiency disorders (CVID) [30,31]. With respect to a possible role of T-lymphocytes, particularly in HIV-positive patients, CD4-lymphopenia was found to correlate with increased seroprevalence of anti HEV IgG [10].…”

Section: Discussionmentioning

confidence: 98%

Rituximab-Containing Treatment Regimens May Imply a Long-Term Risk for Difficult-To-Treat Chronic Hepatitis E

Schulz

Biedermann

Bock

et al. 2020

IJERPH

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Hepatitis E virus (HEV) infection is an emerging disease in industrialized countries which is usually characterized by a self-limited course. However, there is an increased risk of HEV persistence in immunocompromised risk populations, comprising patients following solid organ transplantation or hematological malignancies. Recently, chronic HEV infection following rituximab-containing treatment regimens has been described. Here we report five patients with chronic hepatitis E after prior rituximab therapy for various indications. We determined the immunological characteristics of these patients and analyzed the development of ribavirin (RBV) treatment failure-associated mutations in the HEV genome. One patient became chronically HEV-infected 110 months after administration of rituximab (RTX). Immunological characterization revealed that all patients exhibited significant hypogammaglobulinemia and CD4+ T cell lymphopenia. One patient permanently cleared HEV following weight-based ribavirin treatment while three patients failed to reach a sustained virological response. In depth mutational analysis confirmed the presence of specific mutations associated with RBV treatment failure in these patients. Our cases indicate that rituximab-containing treatment regimens might imply a relevant risk for persistent HEV infection even years after the last rituximab application. Moreover, we provide further evidence to prior observations suggesting that chronically HEV infected patients following RTX-containing treatment regimens might be difficult to treat.

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Characterising the risk of Hepatitis E virus infection in haematological malignancies: a UK prospective prevalence study

Cited by 8 publications

References 10 publications

Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients

Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients

Hepatitis E seroprevalence and viremia rate in immunocompromised patients: a systematic review and meta‐analysis

Rituximab-Containing Treatment Regimens May Imply a Long-Term Risk for Difficult-To-Treat Chronic Hepatitis E

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