Evaluation of hepatitis E antigen kinetics and its diagnostic utility for prediction of the outcomes of hepatitis E virus genotype 1 infection

Abstract

HEV-Ag ELISA assay is a reliable diagnostic test in resource-limited areas. HEV genotype 1 (HEV-1) infections are either self-limited or progress to fulminant hepatic failure (FHF) and death if anti-HEV therapy is delayed. Limited data is available about the diagnostic utility of HEV Ag on HEV-1 infections. Herein wWe aimed to study the kinetics of HEV Ag during HEV-1 infections at different stages, i.e., acute HEV infection, recovery, and progression to FHF. Also, we evaluated the diagnostic utility of this marker to predict the outcomes of HEV-1 infections. Plasma of acute hepatitis E (AHE) patients were assessed for HEV RNA by RT-qPCR, HEV Ag, and anti-HEV IgM by ELISA. The kinetics of HEV Ag was monitored at different time points; acute phase of infection, recovery, FHF stage, and post-recovery. Our results showed that the level of HEV Ag was elevated in AHE patients with a significantly higher level in FHF patients than recovered patients. We identified a plasma HEV Ag threshold that can differentiate between self-limiting infection and FHF progression with 100% sensitivity and 88.89% specificity. HEV Ag and HEV RNA have similar kinetics during the acute phase and self-limiting infection. In the FHF stage, HEV Ag and anti-HEV IgM have similar patterns of kinetics which could be the cause of liver damage. In conclusion, the HEV Ag assay can be used as a biomarker for predicting the consequences of HEV-1 infections which could be diagnostically useful for taking the appropriate measures to reduce the complications, especially for high-risk groups.

Hepatitis E and Pregnancy: An Unholy Alliance Unmasked from Kashmir, India

“…Recent studies have shown that symptomatic HEV infections do occur in elderly people and those with pre-existing liver diseases. [ 50 , 51 , 52 ]. Seroprevalence studies have shown high occurrence of asymptomatic infections in the general population as well as pregnant women [ 53 , 54 ].…”

Hepatitis E Virus Immunopathogenesis

“…Furthermore, veterinarians could be at risk for the development of chronic HEV infection [57][58][59]. Similarly, hematological malignancies, age, and a history of pre-existing liver diseases are considered as risk factors for the development of FHF caused by HEV gt1 [60,61]. In addition, HEV gt3 is linked to acute nontravelassociated hepatitis E, which can appear as fulminant hepatitis with encephalopathy and coagulation disorders [62].…”

Hepatitis E Virus Infection—Immune Responses to an Underestimated Global Threat

“…Since HEV infection can exacerbate the course of hematologic diseases [ 147 ], adequate therapy is essential. Frequently, infections with the genotype HEV-1 lead to fatal courses, especially if the patients are of advanced age [ 175 , 176 ]. Reducing immunosuppression in hematologic patients is often difficult, which is why balanced administration of ribavirin is also an important pillar in this context [ 147 , 151 , 163 ].…”