The Prevalence of Hepatitis E in a Patient Cohort Presenting With Addictive Injection Behavior

Abstract

Introduction: Hepatitis E is the most common cause of acute viral hepatitis worldwide. Seroprevalence is approximately 15% in developed countries, and 22% in France. hepatitis E virus (HEV) can be transmitted via transfusions and therefore possibly intravenous (IV) drug use. Hepatitis E serology is routinely tested in patients who seek medical advice for addictive injection behavior at the addiction treatment, support and prevention unit of Toulouse University Hospital. We assume that hepatitis E is more prevalent in patients presenting with addictive injection behavior than in the general French population. Methods: Hepatitis E serological assays [immunoglobulin M (IgM) and IgG] were carried out for all patients presenting with addictive injection behavior during an initial evaluation. The controls were taken from a cohort of 3,353 blood donors living in southern France and who donated blood during the first 2 weeks of October 2011. Results: We included 52 patients presenting with addictive injection behavior and 103 healthy controls matched for age, sex, and area of residence. We found no difference between patients and controls for the prevalence of hepatitis E: patients vs. healthy controls: positive IgGs: 42.31%, 95% confidence interval (CI) (28.73–56.80%) vs. 43.43%, 95% CI (33.50–53.77%) (p = 0.89) and positive IgMs: 3.85%, 95% CI (0.47–13.22%) vs. 4.85%, 95% CI (0.16–10.97%) (p = 0.57). Conclusion: There was no difference in HEV seroprevalence between IV drug users and the general population, suggesting that the IV route of HEV infection is not significant in this population.

Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

“…Studies of HEV PCR positivity rates of blood donors worldwide [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]; Table S2. Studies of HEV seroprevalence of blood donors worldwide [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70...…”

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

“…However, the control populations in most studies were unmatched to the PWID groups, even for age, which is a major determinant of HEV seropositivity [ 30 , 31 ]. Only one study included an age- and sex-matched control population [ 13 ]. However, a limitation of this study was its small sample size of only 52 PWIDs.…”

“…However, the importance of addictive injection behavior as a risk factor for hepatitis E is uncertain. HEV IgG seroprevalence among PWIDs in Europe and North America ranges from 2.8–62% [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Comparisons of the HEV seroprevalence between PWIDs and non-drug-using control groups have produced conflicting results; some studies have found significant differences [ 18 , 19 , 21 ], while others have concluded that PWIDs are not at increased risk of hepatitis E [ 13 , 15 , 16 ].…”

“…HEV IgG seroprevalence among PWIDs in Europe and North America ranges from 2.8–62% [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Comparisons of the HEV seroprevalence between PWIDs and non-drug-using control groups have produced conflicting results; some studies have found significant differences [ 18 , 19 , 21 ], while others have concluded that PWIDs are not at increased risk of hepatitis E [ 13 , 15 , 16 ]. Most studies had significant methodological issues such as small sample sizes [ 18 , 22 , 23 ], unmatched control populations [ 17 , 18 , 20 , 21 , 23 , 24 ], or control populations that are not representative of the general population such as hepatitis C virus (HCV) carriers, prisoners or homeless persons [ 14 , 18 , 20 , 23 ].…”