Persistent Hepatitis E virus infection across England and Wales 2009‐2017: Demography, virology and outcomes

Ankcorn, Michael; Said, B.; Morgan, Dilys; Elsharkawy, Ahmed M.; Maggs, James; Ryder, Stephen D.; Valliani, Talal; Gordon, F.; Abeysekera, Kushala; McPherson, Stuart; Galliford, Jack; Smith, Belinda; Pelosi, Emanuela; Bansal, Sanjay; Bethune, Claire; Sheridan, David; Vine, Louisa; Tedder, Richard S.; Ijaz, Samreen

doi:10.1111/jvh.13424

Cited by 14 publications

(17 citation statements)

References 39 publications

(72 reference statements)

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“…A series of 94 patients with persistent HEV infection (viraemia of more than 12 weeks) from England and Wales showed that all patients were immunocompromised: 70.2% were transplant recipients, 17% had an underlying haematological malignancy and 6% had advanced HIV infection. Seventeen per cent of the 65 patients treated by ribavirin, had a virological relapse 30 …”

Section: Chronic Hepatitismentioning

confidence: 99%

“…These patients may experience viral clearance over time and the return of immunity. This may induce a rebound in cytolysis and severe acute hepatitis 30 …”

Section: Chronic Hepatitismentioning

confidence: 99%

“…Seventeen per cent of the 65 patients treated by ribavirin, had a virological relapse. 30 In chronic hepatitis, liver enzymes are usually moderately elevated and patients are often asymptomatic. The incidence of infection with genotype 3 HEV after organ transplantation was 3.2/100 person-years in the southwest of France.…”

Section: Chroni C Hepatitismentioning

confidence: 99%

“…This may induce a rebound in cytolysis and severe acute hepatitis. 30 Chronic hepatitis only occurs in patients infected with HIV when there is a very low CD4 count, always <250/mm 3 . 34 There is a risk of progression to cirrhosis in these cases.…”

Section: Chroni C Hepatitismentioning

confidence: 99%

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Hepatitis E, what is the real issue?

Larrue

Abravanel

Péron

2021

Liver International

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Hepatitis E virus (HEV) infection is a worldwide disease and the primary cause of acute viral hepatitis with an estimated 3.3 million symptomatic cases every year and 44,000 related deaths. It is a waterborne infection in the developing countries. In these countries, HEV genotypes 1 and 2 cause large outbreaks and affect young subjects resulting in significant mortality in pregnant women and patients with cirrhosis. In developed countries, HEV genotypes 3 and 4 are responsible for autochthonous, sporadic hepatitis and transmission is zoonotic. Parenteral transmission by the transfusion of blood products has been identified as a potential new mode of transmission. HEV can also cause neurological disorders and chronic infections in immunocompromised patients. The progression of acute hepatitis E is usually asymptomatic and resolves spontaneously. Diagnosis is based on both anti‐HEV IgM antibodies in serum and viral RNA detection in blood or stools by PCR in immunocompetent patients, while only PCR is validated in immunocompromised individuals. Ribavirin is the only validated treatment in chronic infection. A vaccine has been developed in China.

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Section: Chronic Hepatitismentioning

confidence: 99%

“…These patients may experience viral clearance over time and the return of immunity. This may induce a rebound in cytolysis and severe acute hepatitis 30 …”

Section: Chronic Hepatitismentioning

confidence: 99%

Section: Chroni C Hepatitismentioning

confidence: 99%

Section: Chroni C Hepatitismentioning

confidence: 99%

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Hepatitis E, what is the real issue?

Larrue

Abravanel

Péron

2021

Liver International

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“…It is therefore worthwhile to emphasize the reason for and the way in which these patients are immunosuppressed in order to learn more about the mechanisms involved. A recent study by Ankcorn et al [ 138 ] investigated patients suffering from persistent HEV infection over a long period of time for underlying disorders. A history of SOT was present in approximately 60% of the patients.…”

Section: Clinical Link Between Lymphoid Cell Impairment and Hev Outcomementioning

confidence: 99%

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

Kupke

Werner

2021

Cells

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Infection with the hepatitis E virus (HEV) is one of the main ubiquitous causes for developing an acute hepatitis. Moreover, chronification plays a predominant role in immunocompromised patients such as transplant recipients with more frequent severe courses. Unfortunately, besides reduction of immunosuppression and off-label use of ribavirin or pegylated interferon alfa, there is currently no specific anti-viral treatment to prevent disease progression. So far, research on involved immune mechanisms induced by HEV is limited. It is very difficult to collect clinical samples especially from the early phase of infection since this is often asymptomatic. Nevertheless, it is certain that the outcome of HEV-infected patients correlates with the strength of the proceeding immune response. Several lymphoid cells have been identified in contributing either to disease progression or achieving sustained virologic response. In particular, a sufficient immune control by both CD4+ and CD8+ T cells is necessary to prevent chronic viral replication. Especially the mechanisms underlying fulminant courses are poorly understood. However, liver biopsies indicate the involvement of cytotoxic T cells in liver damage. In this review, we aimed to highlight different parts of the lymphoid immune response against HEV and point out questions that remain unanswered regarding this underestimated global threat.

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