Serological investigation for hepatitis E virus infection in the patients with chronic maintenance hemodialysis from southwest of Iran

Abstract

Background and Objectives:A global distribution has been shown for hepatitis E virus (HEV) infection. Although the fecal-oral was considered as the primary infection route, there is controversial evidence for increased risk of the infection and consequent problems in patients on maintenance hemodialysis (HD) with suppressed immunity. The aim is to find if the prevalence of anti-HEV IgG, in patients with maintenance HD is higher than normal population in southwest of Iran.Materials and Methods:During November and December 2010, in a cross-sectional study we compared the seroprevalence of HEV among 80 patients with maintenance HD and 276 healthy individuals from Jahrom and Shiraz, Southwest of Iran. In addition to the clinical and laboratory records, serum samples were tested for the presence of IgG anti-HEV antibody by enzyme immunoassay (ELISA) test. The Chi-square, the Student's ‘t’ and Fisher's exact tests were used for the statistical analysis.Results:ELISA tests detected anti-HEV antibody in five males of the patients (6.3%) and in eight of the healthy controls (2.9%, 6 males and 2 female) which statistically were not different. The mean levels of the aspartate aminotransferase and the alanine aminotransferase in the sera of the patients were 19.96±11.08U/L and 23.93±14.26 IU/L, respectively. However, no one of the individuals with positive anti-HEV antibody showed elevated liver enzymes. Moreover, there was not a significant association between positive anti-HEV antibody result, age and the history of the hemodialysis.Conclusions:We did not observe statistically significant higher anti-HEV prevalence among patients with chronic HD; however, more safety precaution is needed to keep HD patients from the risk of possible exposure to HEV infection.

Infection by Brazilian and Dutch swine hepatitis E virus strains induces haematological changes in Macaca fascicularis

“…In contrast, cynomolgus monkey I3 (Table 2 ) showed lymphopenia, prolonged viraemia (starting at 39 dpi), and faecal shedding (starting at 19 dpi) without seroconversion until the end of the experiment and possibly beyond that period. Such a pattern of prolonged viraemia and viral elimination without seroconversion or liver enzyme elevation has been described for HEV-infected, immunocompromised individuals [ 42 - 44 ], haemodialysis patients [ 45 ], and an immature neonate [ 44 ]. The protective roles of specific antibodies in controlling HEV infection have been confirmed in non-human primate studies [ 40 , 46 - 48 ] for both naturally acquired and experimentally induced infections [ 38 , 48 , 49 ] and in convalescent human patients [ 50 ].…”

Anti-Hepatitis E Antibody in Hemodialysis Patients in Isfahan, Iran: Prevalence and Risk Factors

“…Moreover, a significant level of the IgG antibody is cleared during the process of hemodialysis. Therefore, using antibody markers to detect HEV infection is accompanied by some shortcomings, especially in HD patients ( 14 ).…”

“…Data concerning the seroprevalence of HEV infection among HD patients have presented conflicting results. The HEV seropositivity rates reported in HD patients for different countries range as low as 0.9% in France and 2.6% in Italy and as high as 7.3% or more among the adult population in Spain or in Brazil ( 14 ). A case-control study using serology assays conducted in Saudi Arabia reported a prevalence of 4.8% in 83 chronic HD patients vs. 0.3% in healthy controls.…”

Prevalence of anti-hepatitis E virus IgG antibodies in sera from hemodialysis patients in Tripoli, Lebanon

“…In this context, Sylvan et al previously reported no significant difference between HEV antibodies in Swedish HD patients (6%) and control subjects (5.2%) and no IgG anti-HEV seroconversion during chronic HD [38]. An additional report from Iran also did not found statistically significant higher anti-HEV IgG prevalence among patients with chronic HD [39].…”