Temporal profile of HEV RNA concentration in blood and stool from patients with acute uncomplicated hepatitis E in a region with genotype 1 predominance

Abstract

Acute hepatitis E virus (HEV) is associated with viremia and faecal excretion of the virus. The information on duration and temporal pattern of viremia and faecal shedding in HEV infection is important, but is not available. Serial serum and stool specimens were collected from patients with acute hepatitis E (typical clinical picture, serum alanine aminotransferase levels > 5‐folds the upper limit of normal and presence of IgM anti‐HEV), beginning from within 7 days of the onset of symptoms. HEV RNA concentrations were measured in sera and 10% stool suspensions, using a real‐time Taqman‐based nucleic acid amplification assay. Seventeen patients (median age 25 [range 19‐61] years; all men) were enrolled within a median of 5 (range 3‐8) days of the onset of the first symptom and provided 113 serum specimens and 71 stool specimens. The median (range) highest levels of serum bilirubin, alanine aminotransferase and aspartate aminotransferase in the patients were 10.3 (5.9‐43.4) mg/dL, 1817 (442‐4642) IU/L and 1016 (88‐4561) IU/L, respectively. All the 17 patients had demonstrable viremia, and 12 of the 13 patients who were tested had faecal excretion at one or more time points. The HEV RNA titres were the highest in the early phase of disease and declined rapidly with time, becoming nondetectable in the serum by day 20 and in the stool by day 21. In most of the patients with acute uncomplicated acute hepatitis E, the degree of viremia and faecal shedding decline quickly after the onset of clinical illness and rapidly disappear in parallel with each other.

Seroprevalence of Hepatitis E virus in children and adolescents living in urban Bogotá: An explorative cross-sectional study

“…While IgM antibodies decline more rapidly after an acute infection and can be detectable only for a few months after onset of symptoms, IgG antibodies can persists for at least 1 year ( 71 , 72 ). RNA on the contrary declines even more rapidly, and it is not detectable in the serum by day 20 after onset of symptoms ( 73 ). Therefore, the other two HEV IgG-reactive samples might indicate an even earlier infection as no IgM were identified in them.…”

Hepatitis E Virus in Water Environments: A Systematic Review and Meta-analysis

“…The vast majority of the data (n = 20) showed prevalence > 10%. The high prevalence in untreated water can be explained by the excretion of the virus via contaminated faeces or urine from infected individuals (Abravanel et al, 2015;Chandra et al, 2010;Geng et al, 2016;Goel et al, 2020;Takahashi et al, 2007). Before the onset of disease symptoms, up to 1 × 10 5 HEV genome copies per gram of faeces can be excreted for several days (Li et al, 2006).…”

Significant compartment‐specific impact of different RNA extraction methods and PCR assays on the sensitivity of hepatitis E virus detection

“…Additionally, this body compartment may change drastically in composition of interfering factors (digestive enzymes, pH, dilution by fluids), which makes a robust and reliable assay set-up difficult. 17 Previous studies showed a longer shedding of viral RNA in acutely as well as chronically infected HEV patients 16,18 pointing to an even increased rate of HEV RNA-positive patients at EOT in stool as compared to plasma. This further underlines the need for harmonization and specification for markers as predictors for viral relapses.…”