Hepatitis E Virus (HEV) Infection in Hemodialysis Patients: A Multicenter Epidemiological Cohort Study in North-Eastern Greece

Abstract

Hepatitis E virus (HEV), a common cause of viral hepatitis in developing countries, is mainly transmitted via the fecal–oral route, but also may be a prevalent hospital-transmitted agent among patients on regular hemodialysis due to parenteral transmission. Previous epidemiological studies among hemodialysis patients in Greece, using different diagnostic techniques, gave conflicting results. Τhe present study aimed to measure the exposure rate of hemodialysis patients of north-eastern Greece to HEV by estimating the overall seroprevalence, and to identify potential risk factors. Serum samples from all patients attending the hemodialysis centers of north-eastern Greece (n = 6) were tested for the presence of anti-HEV IgG antibodies using a modern and sensitive ELISA (Enzyme-linked Immunosorbent Assay) technique (Wantai). In total, 42 out of 405 hemodialysis patients were positive for anti-HEV IgG (10.4%), while all samples were negative for HEV RNA when tested using nested RT-PCR. HEV seropositivity among hemodialysis patients was significantly associated with area of residence and contact with specific animals (pork, deer). No association was found with religion, gender distribution and hemodialysis duration. This study showed an increased seroprevalence of HEV among hemodialysis patients in Greece. Agricultural or livestock occupation and place of residence seem to be independent factors that increase the risk of HEV infection. In conclusion, HEV infection calls for the regular screening of hemodialysis patients regardless of the hemodialysis duration or clinical symptoms.

Hepatitis E Virus (HEV) Infection among Hemodialysis Patients from Southern Bulgaria

“…The observed rise in the proportion of HEV-positive HD patients with increasing age, although not statistically significant (Figure 2), has been similarly documented in other research centers [6,41,42,47]. This phenomenon can be partially attributed to the tendency of dialysis research to primarily focus on the adult population (≥18 years old), rather than encompassing the entire age range typically observed in population studies.…”

“…This assertion is substantiated by the authors' previous findings, which indicated a seroprevalence rate of 65.1% among individuals who were not undergoing hemodialysis. Prior studies undertaken in Greece at different time periods have shown significant discrepancies among dialysis centers across various locations of the nation [6,22]. Nevertheless, the findings of our study did not reveal any significant variations, as seen by the data presented in Table 2.…”

“…This rate is much higher compared to the lower prevalence of 7.1% among the general population in the country [16]. When assessing the extent of HEV seroprevalence, it is important to take into account many aspects that may have an impact, including the specific diagnostic tests employed [6,44], the duration of the study, the criteria for participant inclusion, and the dynamics of the antibodies themselves. In comparison to the persistent detection of anti-HAV IgG in the serum of individuals throughout their lives, the precise length of the immune response generated by anti-HEV IgG antibodies remains unknown [45].…”

“…In contrast to what was anticipated, the findings of our study revealed a divergent conclusion. Several writers have provided evidence of a relationship between the incidence of HEV and the individual's place of residence, particularly in respect to geographical location [5,6]. The aforementioned association takes into account local customs such as dietary habits, outdoor activities, and involvement in agricultural practices.…”

“…Nevertheless, current data extending to January 2020 have presented compelling evidence indicating that blood transfusion is linked to a roughly two-fold increase in the prevalence of HEV seropositivity among HD patients [4]. Hepatitis E in hemodialysis patients originating from Eastern European nations, particularly in the Balkans, has received limited attention in academic research [5][6][7][8]. Insufficient data referring specifically to Bulgaria are evident [9].…”