Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C

Bricks, Guilherme; Senise, Jorge Figueiredo; Pott-Jr, Henrique; Grandi, Giuliano; Carnaúba-Jr, Dimas; Moraes, Hamilton Antonio Bonilha de; Granato, Celso; Castelo, Adauto

doi:10.1016/j.bjid.2019.02.002

Cited by 12 publications

(13 citation statements)

References 24 publications

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“…The clinical presentation of HEV infection varies from mild and self-limiting to severe cases with typical features of hepatitis: malaise, abdominal, muscle and joint pain, anorexia, and jaundice (Purcell and Emerson, 2008; Lewis et al, 2010), which can end up as fulminant hepatitis. Furthermore, chronic hepatitis has recently been reported in patients with immune disorders and that is hepatically compromised (Bricks et al, 2019; Yang et al, 2019). For unclear reasons, the incidence of fulminant hepatitis in pregnant women is up to 20% (Purcell and Emerson, 2008; Lewis et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina

et al. 2019

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The Hepatitis E virus (HEV) is an emergent virus that causes acute hepatitis in immunocompetent hosts and chronic hepatitis in immunocompromised hosts. In Latin America, the main circulating genotype HEV-3 is usually of zoonotic origin. Diagnosis and seroprevalence studies mainly rely on the detection of specific antibodies. There are scarce data on the seroprevalence of HEV infection in Latin America mainly due to the lack of awareness of HEV circulation. Furthermore, in some countries, like Argentina, HEV testing is not included in routine assays. In order to provide tools to deepen the knowledge on HEV epidemiology in South America, we designed a new in-house ELISA based on the native recombinant protein ORF2 aa112–608 and demonstrated its potential for detecting anti-HEV immunoglobulin G (IgG) in human serum samples. The following conditions were determined: an optimal antigen concentration of 0.25 μg/ml, a serum dilution of 1:80, gelatin as a blocking agent, and a secondary antibody dilution of 1:2000. A relative sensitivity of 93.33% (95% CI: 77.9–99.2%) and a relative specificity of 99.4% (95% CI: 96.7–100%) were determined using a panel of previously characterized sera and a gold standard (HEV IgG ELISA, DIA.PRO, Italy). Further, we obtained a very good agreement (κ index = 0.94, 95% CI: 0.87–1.00) with the gold standard. We screened 813 blood donor samples with this newly developed ELISA and found a seroprevalence of 9.23% (95% confidence interval, 7.33–11.43%). We show for the first time evidence of past HEV infection in Tucuman, the most populated city in northern Argentina. We expect that this study will raise the interest of health decision makers who should intercede to include indirect testing of HEV in regular diagnostic protocols. In conclusion, the in-house ELISA developed in this work shows a very good agreement with an already licensed commercial HEV IgG ELISA (DIA.PRO, ITALY), which can be used as an epidemiologic tool for HEV surveillance.

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Section: Introductionmentioning

confidence: 99%

A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina

et al. 2019

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“…This has major implications, as PWIDs already have a high incidence of liver disease due to alcoholism, chronic hepatitis B and hepatitis C carriage [ 36 ]. HEV superinfections in such vulnerable patients could result in acute hepatic decompensation as has been shown in other studies [ 37 , 38 ]. Furthermore, PWIDs are also susceptible to HIV infection, which is a known risk factor for chronic hepatitis E infection [ 39 ].…”

Section: Discussionmentioning

confidence: 58%

“…Even after exclusion of non-Chinese patients, the HEV seroprevalence in the PWID group (40/82) was significantly higher than the donor group ( p < 0.001), showing that the association was independent of the geographical origin of the patients. Although HCV-HEV co-infections are well described and prior HEV infection may accelerate HCV-related fibrosis, HCV carriage by itself would not independently increase risk of HEV acquisition [ 32 , 38 ]. Although we did not have a detailed dietary history in our study subjects, Hong Kong is an urban society with relatively homogenous food consumption habits.…”

Section: Discussionmentioning

confidence: 99%

Risk of Hepatitis E among Persons Who Inject Drugs in Hong Kong: A Qualitative and Quantitative Serological Analysis

et al. 2020

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Hepatitis E virus (HEV) is an important cause of hepatitis, which can be transmitted via the bloodborne route. However, risk of hepatitis E among persons who inject drugs (PWIDs) is poorly understood. This study aimed to elucidate whether PWIDs are at risk for hepatitis E. We performed HEV IgM, IgG and nucleic acid detection on a cohort of 91 PWIDs and 91 age- and sex-matched organ donors. Blood HEV IgG was measured using the WHO HEV antibody standard. The effects of age, gender and addictive injection use on HEV serostatus and concentration were assessed. HEV IgG seroprevalence was 42/91 (46.2%) in the PWID group and 20/91 (22%) in the donor group (odds ratio = 3.04 (1.59–5.79), p = 0.0006). The median HEV IgG concentration was 5.8 U/mL (IQR: 2.5–7.9) in the PWID group and 2.1 U/mL (IQR: 1.2–5.3) in the donor group (p = 0.005). Increasing age and addictive injection use were significantly associated with HEV IgG serostatus, but only addictive injection use was associated with HEV IgG concentration (p = 0.024). We conclude that PWIDs are at increased risk for hepatitis E and are prone to repeated HEV exposure and reinfection as indicated by higher HEV IgG concentrations.

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“…It has been reported that HEV infection could negatively impact the prognosis of patients with chronic liver diseases [23,24]. However, in Latin America there is only one recent report from Brazil about HEV infection in individuals with chronic liver disease [17], and no data documented in Argentina.…”

Section: Discussionmentioning

confidence: 99%

Unexpected high seroprevalence of hepatitis E virus in patients with alcohol-related cirrhosis

et al. 2019

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IntroductionLittle is known about hepatitis E virus (HEV) infection in patients with cirrhosis. The aim of the present study was to describe the frequency of HEV infection and associated risk factors in patients with cirrhosis from Argentina.Materials and methodsWe evaluated HEV seroprevalence (IgG anti-HEV) and acute infections (IgM and RNA) in patients with cirrhosis (n = 140) vs. healthy controls (n = 300). Additionally, we compared the same outcomes in individuals with alcohol-related cirrhosis (n = 43) vs. patients with alcohol use disorder (without cirrhosis, n = 72).ResultsThe overall HEV seroprevalence in the cohort of subjects with cirrhosis was 25% (35/140), compared to 4% in the healthy control group [12/300; OR = 8; (95% CI = 4–15.99); p<0.05]. HEV seropositivity was significantly higher in alcohol-related cirrhosis compared to other causes of cirrhosis [39.5% vs. 12.4%; OR = 4.71; (95% CI = 1.9–11.6); p<0.05] and to healthy controls [OR = 15.7; (95% CI = 6.8–36.4); p = 0.0001]. The HEV seroprevalence in alcoholic-related cirrhosis vs. with alcohol use disorder was 39.5% vs. 12.5% [OR = 4.58; (95% CI = 1.81–11.58); p<0.001].ConclusionWe found a high seroprevalence of HEV in patients with cirrhosis and in individuals with alcohol use disorder. The simultaneous presence of both factors (cirrhosis + alcohol) showed more association to HEV infection. Larger studies with prospective follow up are needed to further clarify this interaction.

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Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C

Cited by 12 publications

References 24 publications

A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina

A Novel In-House Enzyme-Linked Immunosorbent Assay for Genotype 3 Hepatitis E Virus Reveals High Seroprevalence in Blood Donors in Northern Argentina

Risk of Hepatitis E among Persons Who Inject Drugs in Hong Kong: A Qualitative and Quantitative Serological Analysis

Unexpected high seroprevalence of hepatitis E virus in patients with alcohol-related cirrhosis

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