Past and current hepatitis E virus infection in renal transplant patients

Abstract

The chronic course of hepatitis E virus infection in immunosuppressed patients has been recently documented; however, clinical features and factors associated with this occurrence are not well known. The aim of this study was to evaluate the prevalence of previous or current HEV infection in renal transplant patients. One hundred ninety-two kidney transplant patients were studied and classified in three groups: G1-infected with hepatitis B and/or C virus; G2-patients with elevated ALT; G3-patients with normal ALT and no hepatotropic virus infection. Demographic, epidemiologic and clinical characteristics were compared between the groups. Patients with HEV infection (previous or current) were also compared to those who tested negative for HEV. HEV infection was detected using serologic (anti-HEV IgG) and molecular (HEV RNA) methods. Anti-HEV IgG was positive in 28 (15%) while HEV RNA was positive in 20 (10%). When both markers were considered, 44 (23%) patients showed evidence of previous or current HEV infection. However, both markers were concomitantly positive in only four cases (2%). In the comparative analysis, patients infected with HBV and/or HCV showed lower frequency of anti-HEV IgG (P = 0.009). There was no difference regarding demographic, epidemiologic and laboratory variable between viremic and non-viremic patients. In conclusion, past and current infection with HEV was a frequent finding among renal transplant recipients. Actively infected patients (HEV RNA positive) did not present distinct demographic and epidemiological characteristics or laboratory alterations suggestive of underlying liver damage. Therefore, infection with HEV can only be detected in immunosuppressed patients by systematic investigation of HEV RNA.

Cynomolgus monkeys are successfully and persistently infected with hepatitis E virus genotype 3 (HEV-3) after long-term immunosuppressive therapy

“…So far, HEV infection in Brazil is similar to that observed in developed countries, with HEV-3 being detected in humans and pigs [3, 6, 36]. Indeed, few indigenous cases of human hepatitis E have been described in Brazil, mostly in SOT immunosuppressed patients, all classified within genotype 3 [4, 5, 36]. The present study describes a successful experimental chronic infection of immunosuppressed cynomolgus monkeys with a Brazilian swine HEV-3 isolated from a naturally infected pig.…”

High frequency of hepatitis E virus infection in swine from South Brazil and close similarity to human HEV isolates

“…This country has been classified as moderately endemic for HEV, with seroprevalence from 1% to 4% in blood donors or the general population, 13% in individuals from an agricultural settlement in the Amazon Basin, and 15% in renal transplant recipients 10, 11, 12, 13. A more recent study observed a seroprevalence of anti-HEV IgG antibodies of 10% among blood donors in the metropolitan area of Itajai Valley, Southern Brazil, a region of predominant German ancestry where cultural habits result in a high pork consumption 14 .…”

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].…”