First report and molecular characterization of hepatitis E virus infection in renal transplant recipients in Brazil

Abstract

Hepatitis E virus (HEV) causes acute and chronic hepatitis in organ transplant recipients. Serological evidence for HEV infection has been discovered in various population groups in Brazil, and a single acute case has been confirmed. To date, however, no cases of HEV infection in immunocompromised patients have been reported in Brazil. This study aimed to identify and characterize hepatitis E cases in renal transplant recipients in Brazil. A retrospective study was performed on 96 serum samples from renal transplant recipients with unexplained liver enzymes elevation. Three confirmed cases of HEV infection were identified that lacked seroconversion to HEV IgG antibodies. The prevalence of HEV in these patients was 3.1%. Using a sequence analysis of a 304-nucleotide fragment within ORF2, the strains were classified as genotype 3 with a low percent identity to previously characterized strains. This is the first report of hepatitis E infection in renal transplant recipients in Brazil, and the data indicate that a novel genotype 3 subvariant may be present and that further investigation is necessary to characterize the circulating HEV strains. In this setting, HEV infection should be considered as a potential cause of abnormal liver tests of unknown origin.

Lack of persistent hepatitis E virus infection as a cause for unexplained transaminase elevation in renal transplant recipients in India

“…Given the high rate of exposure to HEV infection in the Indian population, if genotype 1 HEV infection has the potential to cause persistent infection among immunosuppressed persons, one would expect at least some renal transplant recipients to have detectable HEV RNA. In fact, in Brazil, where genotype 3 HEV infection occurs among humans, a proportion of unselected renal transplant recipients with mild ALT elevation was indeed found to have detectable HEV viremia [18,19].…”

Hepatitis E

“…Although HEV genotype 1 has been detected, the majority of cases are caused by HEV genotype 3, which is also present in local pig populations. These initial data suggest that the epidemiology of hepatitis E in South America is similar to that in developed countries [7][8][9][10][11].…”

Hepatitis E virus infection in Brazil: results of laboratory-based surveillance from 1998 to 2013

“…Our previous study of 192 renal transplant patients in São Paulo, Brazil identifi ed 20 (10%) patients positive for HEV RNA and 28 (15%) positive for anti-HEV IgG antibodies (7) . The HEV strains were genotype 3; further investigation of 3 patients suggested chronic hepatitis E, although the retrospective study design precluded follow-up (8) .…”