Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

Gerven, Nicole M. van; Eijk, Annemiek A. van der; Pas, Suzan D.; Zaaijer, Hans L.; Boer, Ynto S. de; Witte, Birgit I.; Nieuwkerk, C.M. van; Mulder, Chris J.; Bouma, Gerd; Man, Robert A. de; Drenth, J.P.H.

doi:10.15403/jgld.2014.1121.251.hpe

Cited by 40 publications

(35 citation statements)

References 22 publications

(33 reference statements)

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“…However, these results could not be reproduced in a cohort of AIH patients from the Netherlands [15], where the incidence of HEV is particularly high [16]. HEV IgG seroprevalence in both AIH and blood donors was around 27% [15].…”

Section: Introductionmentioning

confidence: 83%

Autoimmune liver disease serology in acute hepatitis E virus infection

Beretta‐Piccoli

Ripellino

Gobbi

et al. 2018

Digestive and Liver Disease

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Section: Introductionmentioning

confidence: 83%

Autoimmune liver disease serology in acute hepatitis E virus infection

Beretta‐Piccoli

Ripellino

Gobbi

et al. 2018

Digestive and Liver Disease

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“…Recently, a German and an Austrian study supported this hypothesis by showing a higher anti‐HEV IgG prevalence in AIH patients compared to that in the general population 12,13 . However, a larger Dutch study showed no significant difference in the anti‐HEV prevalence between AIH patients and the general population; thus, this association remains controversial 14 . The anti‐HEV IgG prevalence among the general population in South Korea has been reported variously from 9% to 34%; however, the nationwide number of confirmed diagnostic code of acute hepatitis E is about 60 cases according to National Health Insurance Claims Data (Korea National Institute of Health inner data).…”

Section: Discussionmentioning

confidence: 99%

A case of acute liver failure due to hepatitis E virus, liver transplantation, and development of de novo autoimmune hepatitis

Choi

Ahn

Cho

et al. 2020

Transplant Infectious Dis

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Acute liver failure (ALF) is the rapid loss of liver function due to severe injury to the liver cells, frequently leading to fatal outcomes over days or weeks, usually in previously healthy individuals. Liver transplantation (LT) is a life-saving treatment in approximately 30% of ALF patients who failed to respond to medical treatment. The cause of ALF is diverse including hepatotoxins, viral infection such as the hepatitis A, B, C, D, and E virus, hepatic ischemia, and autoimmune hepatitis. 1 Among them, the hepatitis E virus (HEV) is a positive-strand RNA virus with a 7.2 kb genome transmitted by the fecal-oral route. HEV is currently the most common cause of viral hepatitis globally, as reported by the World Health Organization (WHO): an estimated 20 million HEV infections, 3.3 million symptomatic cases, and 44 000 deaths in 2015. 2 However, there is a massive underestimation of the true burden of HEV infection due to a lack of knowledge among clinicians and the absence of a diagnostic gold standard. 3 HEV is a major cause of ALF in the Indian subcontinent and parts of Africa, but there are no case reports of ALF due to HEV infection in South Korea yet. De novo autoimmune hepatitis (AIH) rarely develops in LT recipients under immunosuppressive therapy who underwent LT due to non-AIH causes, but it shows nearly identical histological features to that of AIH. 4 Here, we report the first case of de novo AIH in a LT recipient after HEV-induced ALF, which suggests that HEV could have Abstract Acute hepatitis E virus (HEV) infection could lead to acute liver failure (ALF), which requires liver transplantation (LT). HEV infection could progress to chronic infection in an immunosuppressed host. De novo autoimmune hepatitis (AIH) is a rare occurrence of AIH during post-LT immunosuppressive therapy in patients who underwent LT due to not AIH but some other etiology. Here, we report the first case of ALF due to HEV infection, the recurrence of HEV after LT that responded to ribavirin therapy, and then the development of de novo AIH showing a complete response to glucocorticoid therapy but multiple relapses after steroid withdrawal. This peculiar case suggests that HEV could have a pathogenic role in the development of the de novo AIH; additionally, this case report could help clinicians make therapeutic decisions in the post-LT condition. K E Y W O R D S acute liver failure, autoimmune hepatitis, hepatitis E virus, liver transplantation How to cite this article: Choi JK, Ahn S, Cho JY, et al. A case of acute liver failure due to hepatitis E virus, liver transplantation, and development of de novo autoimmune hepatitis. Transpl Infect Dis. 2020;22:e13287. https://doi.

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“…However, it is necessary to exclude other causes of hepatitis and evaluate treatment compliance before definitively diagnosing these patients with "difficult-to-manage" AIH. [40][41][42][43][44][45] AIH is an immune-mediated liver disease, thus biological agents, such as infliximab (anti-tumour necrosis factor [TNF] therapy), rituximab (anti-B cell therapy) or even tocilizumab (anti-IL-6 therapy) may have a potential role as disease-modifying agents and salvage therapies. 17,46,47 Anti-TNF treatment (infliximab) has been applied successfully as a rescue therapy in AIH.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of rituximab in difficult-to-manage autoimmune hepatitis: Results from the International Autoimmune Hepatitis Group

et al. 2019

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Graphical abstract Highlights• Study of rituximab therapy in 22 patients with autoimmune hepatitis over a follow-up period of 24 months.• No serious adverse events were noted during followup in patients treated with rituximab.• Rituximab therapy improved liver enzymes significantly during the 2 years of follow-up.• Prednisolone dose reductions were seen in 62% of patients at 12-month follow-up.• A total of 71% of patients were free of AIH flares during the 24 months of follow-up. Lay summaryAutoimmune hepatitis is an autoimmune condition of the liver, usually treated with medications that suppress the immune system, such as steroids. However, some patients do not respond to this treatment. We analysed the safety and efficacy of rituximab in patients who were not responding to firstor second-line therapies. Rituximab was safe and improved liver blood tests in 70% of patients over a 2-year follow-up period, while enabling steroid doses to be reduced in two-thirds of patients, which is a very positive clinical outcome.Background & Aims: Treatment options remain limited for patients with autoimmune hepatitis (AIH), while there are still concerns over the consequences of long-term corticosteroid use. A few studies have suggested a role for B cell-driven autoimmune liver injury in AIH. This multicentre, international retrospective cohort study from the International Autoimmune Hepatitis Group aims to evaluate the clinical efficacy and safety of rituximab in difficult-to-manage AIH.Methods: Clinical data from 22 patients who received rituximab between 2007 and 2017 were collected from centres in the United Kingdom, Germany and Canada. Clinical response was assessed using changes in biochemical and immunological parameters up to 24 months post-rituximab infusion. In addition, we compared the doses of prednisolone used 3 months before and 12 months after treatment, and assessed freedom from AIH flares over the post-treatment period.Results: Twenty-two patients with type-1 AIH were included, with a median age of 40 years at diagnosis (range 19-79); 15/22 (68%) were female and 18/22 (82%) were Caucasian. The median period from diagnosis to the end of follow-up in these patients was 11 years (range 3-28). Values of alanine aminotransferase, aspartate aminotransferase and albumin improved significantly following rituximab therapy, and were sustained for up to 2 years (all p <0.001). Prednisolone doses were significantly reduced by 12 months post-treatment (p = 0.003), with 13/21 (62%) patients having a dose reduction. Over a median post-treatment follow-up period of 6 years (range 1-10), 5 patients developed AIH flares at a median of 22 months post-treatment, giving an estimated 71% freedom from AIH flare at 2 years. Four of these patients received a second course of treatment, of whom 2 had subsequent further flares. No serious adverse events attributable to rituximab were recorded. Conclusion:In patients with difficult-to-manage AIH, rituximab appears to be clinically effective and well tolerated. Rituximab was associated w...

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Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

Cited by 40 publications

References 22 publications

Autoimmune liver disease serology in acute hepatitis E virus infection

Autoimmune liver disease serology in acute hepatitis E virus infection

A case of acute liver failure due to hepatitis E virus, liver transplantation, and development of de novo autoimmune hepatitis

Efficacy of rituximab in difficult-to-manage autoimmune hepatitis: Results from the International Autoimmune Hepatitis Group

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