Hepatitis E virus infection in patients on dialysis and in solid organ transplant recipients in Argentina: exploring associated risk factors

Abstract

Infection with hepatitis E virus (HEV) leads to acute hepatitis infection in immunocompetent hosts. HEV genotype 3 can present with high frequency and lead to chronic infection in individuals with a compromised immune system. The risk factors related to increased seroprevalence or chronicity in this population are not entirely understood. Moreover, most studies addressing risk factors for HEV in non-endemic areas come from developed areas such as North America and Europe. In this study we evaluated seroprevalence, chronicity and risk factors for HEV in 120 transplant recipients and 88 patients on dialysis in Argentina. We found a significantly higher seroprevalence of HEV IgG in those undergoing dialysis compared with healthy controls (10.2% and 4.3% respectively, p = 0.03). No difference in HEV seroprevalence was observed between healthy controls and transplant recipients (5.8%). We found no association between previously identified risk factors for HEV, such as pork consumption or use of tacrolimus, and HEV seroprevalence. In univariate and multivariate analyses, consumption of fish was associated with higher seroprevalence of HEV (OR = 9.33; 95% CI: 2.07-42.2; p = 0.04). None of the samples showed HEV RNA amplification, indicating that chronicity does not seem to be an issue in these cohorts. Our results show increased seroprevalence of HEV in individuals undergoing dialysis but not in transplant recipients. We also found that fish consumption can be a potential risk factor for acquiring HEV.

Prevalence of active hepatitis E virus infection and efficacy of ribavirin treatment in renal allograft recipients

“…We identified concomitant occurrence of anti‐HEV IgM and IgG antibodies without evidence of HEV‐RNA in 2% of renal allograft recipients in concordance with data from other non‐endemic developed countries . Frequency of past HEV infection of 12% in end‐stage chronic renal disease undergoing dialysis treatment was comparable with prevalence rates obtained from recent studies in Italy, Argentina, Greece, and Turkey, but lower than described by research groups from United Kingdom and Japan . Prevalence of past HEV infection with IgM persistence of 2% in our patients on dialysis was low corresponding to the data reported from Italy and Argentina .…”

“…and Turkey, [38][39][40][41] In our cohort, active HEV infection was present in 16 (2%) of 947 renal allograft recipients consistent with previously reported point prevalence rates in SOT recipients ranging from 0.9% to 3.5%, including renal allograft recipients. 4,8,44 All HEV isolates were classified as genotype 3 and no identical isolates were detected.…”

“…Frequency of past HEV infection of 12% in end‐stage chronic renal disease undergoing dialysis treatment was comparable with prevalence rates obtained from recent studies in Italy, Argentina, Greece, and Turkey, but lower than described by research groups from United Kingdom and Japan . Prevalence of past HEV infection with IgM persistence of 2% in our patients on dialysis was low corresponding to the data reported from Italy and Argentina . Scotto et al even described a higher seroprevalence of HEV infection in patients on dialysis compared to renal transplant patients .…”

“…but lower than described by research groups from United Kingdom and Japan 34,42. Prevalence of past HEV infection with IgM persistence of 2% in our patients on dialysis was low corresponding to the data reported from Italy and Argentina 38,39. Scotto et al even described a higher seroprevalence of HEV infection in patients on dialysis compared to renal transplant patients 38.…”

Hepatitis E virus in South America: The current scenario

“…A 10‐year gap in knowledge followed, until 2011, when studies from Argentina, Bolivia, Brazil and Colombia, reported respective HEV prevalences . This wave of studies followed the global reports of chronic hepatitis E virus infection by HEV‐3 in immunosuppressed individuals, especially those with solid organ transplantation as well as the reports of extra‐hepatic manifestations of HEV.…”