Subtype-specific differences in the risk of hospitalisation among patients infected with hepatitis E virus genotype 3 in Belgium, 2010–2018

Subissi, Lorenzo; Peeters, Michael; Lamoral, Sophie; Klamer, Sofieke; Suin, Vanessa; Gucht, Steven Van

doi:10.1017/s0950268819001122

Cited by 30 publications

(30 citation statements)

References 11 publications

(14 reference statements)

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“…A correlation between GT3 subtypes and pathogenicity of acute hepatitis E disease was not observed, perhaps a consequence of the limited datasets. Moreover, it was difficult to compare our findings with data reported in the literature from other European countries, since prior reports did not evaluate symptomatic and asymptomatic patients separately [ 39 ] or comorbidities were not taken into account [ 40 ]. Italian zoonotic strains have often been genotyped by sequencing non-overlapping regions with our sequence target; thus, a comparison between human and animal HEV sequences was limited and was considered to be preliminary in our study.…”

Section: Discussionmentioning

confidence: 87%

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

et al. 2020

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Genotype 3 (GT3) is responsible for most European autochthonous hepatitis E virus (HEV) infections. This study analyzed circulating genotypes and GT3 subtypes in the Lazio region, Italy, between 2011 and 2019, as well as their pathogenic characteristics. Of the 64 evaluable HEV GT3 patient-derived sequences, identified subtypes included GT3f (n = 36), GT3e (n = 15), GT3c (n = 9), GT3a (n = 1) and three unsubtyped GT3 sequences. GT3c strains were similar to Dutch sequences (96.8–98.1% identity), GT3e strains showed high similarity (96.8%) with a United Kingdom sequence, while the most related sequences to GT3f Italian strains were isolated in France, Belgium and Japan. One sequence was closely related to another Italian strain isolated in raw sewage in 2016. The liver functioning test median values for 56 evaluable GT3 patients were: alanine aminotransferase (ALT), 461 (range 52–4835 U/L); aspartate aminotransferase (AST), 659 (range 64–6588 U/L); and total bilirubin, 3.49 (range 0.4–33 mg/dL). The median HEV RNA viral load for 26 evaluable GT3 patients was 42,240 IU/mL (range 5680–895,490 IU/mL). Of the 37 GT3 patients with available clinical information, no correlation was observed between HEV clinical manifestations and GT3 subtype. HEV symptoms were comparable among GT3c/e/f patients across most analyzed categories except for epigastric pain, which occurred more frequently in patients with HEV GT3e (75%) than in patients with GT3c (50%) or GT3f (19%) (p = 0.01). Additionally, patients with HEV GT3c exhibited significantly higher median international normalized ratio (INR) than patients with GT3e and GT3f (p = 0.033). The severity of GT3 acute hepatitis E was not linked to HEV RNA viral load or to the GT3 subtype.

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Section: Discussionmentioning

confidence: 87%

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

et al. 2020

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“…So that autochthonous HEV infection was represented, we actively excluded patients with a recent travel history to Africa or Asia, which are areas endemic for HEV G1 and 2. At the time of writing, a more detailed study of Scottish HEV phylogeny is currently underway could be important as a study of G3 cases in Belgium showed that there was a significantly lower rate of hospital admissions from HEV 3c subtype infections when compared to subtype HEV 3f 32 …”

Section: Discussionmentioning

confidence: 99%

Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: a multicentre retrospective study

Wallace

Swann

Donnelly

et al. 2020

Aliment Pharmacol Ther

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Background: Hepatitis E virus (HEV) is the most common acute viral hepatitis inScotland. Little is known about the burden of morbidity and mortality, which can be high in chronic liver disease or immunocompromised states. Aims:To record the morbidity and mortality of HEV in Scotland. Methods:Demographic, clinical and laboratory data were collected retrospectively from all cases of HEV reported to virology departments across nine NHS health boards, Results: Five hundred and eleven cases were included (Mean age 62, 64% male). 58 (11%) cases had pre-existing cirrhosis and 110 (21%) had diabetes. Three hundred and three patients required admission (59%), totalling 2747 inpatient bed days.Seventeen (3.3%) HEV-related deaths were recorded. Factors that predicted mortality included haematological malignancy (OR 51.56, 95% CI 3.40-782.83, P = 0.005), cirrhosis (OR 41.85, 95% CI 2.85-594.16, P = 0.006), higher serum bilirubin (OR 1.01, 95% CI 1.01-1.02, P = 0.011) and chronic HEV infection (OR 0.02, 95% CI 0.02-0.28, P < 0.001). HEV infection affected 35 transplant patients of 106 total immunosuppressed patients (21%). Of these, 25 patients received Ribavirin therapy with a sustained virological remission of 76%. Thirty-five (6.7%) patients developed acute or acute-on-chronic liver failure with two requiring transplant. Thirty-seven (7.2%) patients reported neurological complications with 10 developing neuralgic amyotrophy, 6 Guillain-Barré and 2 encephalitis. Forty-four (8.6%) patients developed acute kidney injury. Conclusion:In Scotland, HEV causes a significant burden of inpatient admissions, organ failure and death. Cirrhosis and haematological malignancy are significant predictors of mortality. Neurological and renal complications occur in a significant minority. | 975WALLACE Et AL.

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“…It has also been reported that asymptomatic blood donors and patients with symptomatic hepatitis E had similar subtype distributions but that the blood donors had lower virus loads . However, a recent report indicated that patients in Belgium infected with HEV‐3c are at lower risk of hospitalization than those infected with HEV‐3f . We therefore looked for differences in the severity of disease caused by subtype 3f and subtype 3c infections by analysing the clinical and biological parameters from French immunocompetent patients with an HEV infection.…”

Section: Introductionmentioning

confidence: 98%

“…hepatitis E virus, hospitalization, pathogenicity, subtype hospitalization than those infected with HEV-3f. 11 We therefore looked for differences in the severity of disease caused by subtype 3f and subtype 3c infections by analysing the clinical and biological parameters from French immunocompetent patients with an HEV infection.…”

Section: Introductionmentioning

confidence: 99%

Does HEV‐3 subtype play a role in the severity of acute hepatitis E?

Abravanel

Dimeglio

Castanier

et al. 2019

Liver International

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Hepatitis E virus genotype 3 (HEV-3) is a major aetiologic agent of acute hepatitis in industrialized countries. Two main HEV-3 subtypes are found in Europe: subtypes 3c and 3f. We have analysed the clinical and biological parameters from 100 French immunocompetent patients with an HEV subtype 3f or subtype 3c infection, included in a prospective multicentre study. Stepwise regression analysis found that infections with HEV subtype 3f were associated with fever (OR: 6.1 95%CI: 1.4-26.1), have a greater virus load (OR: 7.4; 95%CI: 1.3-42.2) and require more frequent hospitalization (OR: 7.6; 95%CI: 1.1-51.4) than those infected with subtype 3c. The directed acyclic graph strengthens the multivariate analyses indicating a direct link between the HEV subtype, HEV RNA concentration, fever and hospitalization. Further studies on patients in other European countries are needed to confirm this relationship and determine the underlying mechanism. K E Y W O R D S hepatitis E virus, hospitalization, pathogenicity, subtype How to cite this article: Abravanel F, Dimeglio C, Castanier M, et al. Does HEV-3 subtype play a role in the severity of acute hepatitis E? Liver Int. 2020;40:333-337. https ://doi.

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Subtype-specific differences in the risk of hospitalisation among patients infected with hepatitis E virus genotype 3 in Belgium, 2010–2018

Cited by 30 publications

References 11 publications

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

Mortality and morbidity of locally acquired hepatitis E in the national Scottish cohort: a multicentre retrospective study

Does HEV‐3 subtype play a role in the severity of acute hepatitis E?

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