Increased HEV seroprevalence in patients with autoimmune hepatitis.

Abstract

BACKGROUND:

Hepatitis E virus (HEV) infection takes a clinically silent, self-limited course in the far majority of cases. Chronic hepatitis E has been reported in some cohorts of immunocompromised individuals. The role of HEV infections in patients with autoimmune hepatitis (AIH) is unknown.

METHODS:

969 individuals were tested for anti-HEV antibodies (MP-diagnostics) including 208 patients with AIH, 537 healthy controls, 114 patients with another autoimmune disease, rheumatoid arthritis (RA), and 109 patients with chronic HCV- or HBV-infection (HBV/HCV). Patients with AIH, RA and HBV/HCV were tested for HEV RNA. HEV-specific proliferative T cell responses were investigated using CFSE staining and in vitro stimulation of PBMC with overlapping HEV peptides.

RESULTS:

HEV-antibodies tested more frequently positive in patients with AIH (n = 16; 7.7%) than in healthy controls (n = 11; 2.0%; p = 0.0002), patients with RA (n = 4; 3.5%; p = 0.13) or patients with HBV/HCV infection (n = 2; 2.8%; p = 0.03). HEV-specific T cell responses could be detected in all anti-HEV-positive AIH patients. One AIH patient receiving immunosuppression with cyclosporin and prednisolone and elevated ALT levels had acute hepatitis E but HEV viremia resolved after reducing immunosuppressive medication. None of the RA or HBV/HCV patients tested HEV RNA positive.

CONCLUSIONS:

Patients with autoimmune hepatitis but not RA or HBV/HCV patients are more likely to test anti-HEV positive. HEV infection should been ruled out before the diagnosis of AIH is made. Testing for HEV RNA is also recommended in AIH patients not responding to immunosuppressive therapy.

• Authors: Sven Pischke, Anett Gisa, Pothakamuri Venkata Suneetha, Steffen Björn Wiegand, Richard Taubert, Jerome Schlue, Karsten Wursthorn, Heike Bantel, Regina Raupach, Birgit Bremer, Behrend Johann Zacher, Reinhold Ernst Schmidt, Michael Peter Manns, Kinan Rifai, Torsten Witte, Heiner Wedemeyer
• Journal: PloS one (PLoS One) Vol. 9 Issue 1 Pg. e85330 ( 2014) ISSN: 1932-6203 [Electronic] United States
• PMID: 24465537 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hepatitis Antibodies
• RNA, Viral

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Arthritis, Rheumatoid (blood, diagnosis, immunology, virology)
• Case-Control Studies
• Coinfection
• Female
• Hepatitis Antibodies (blood)
• Hepatitis B (blood, diagnosis, immunology, virology)
• Hepatitis C (blood, diagnosis, immunology, virology)
• Hepatitis E (blood, diagnosis, immunology, virology)
• Hepatitis E virus (immunology)
• Hepatitis, Autoimmune (blood, diagnosis, immunology, virology)
• Hepatitis, Chronic
• Humans
• Immunocompromised Host
• Male
• Middle Aged
• RNA, Viral (blood)
• Seroepidemiologic Studies
• T-Lymphocytes (immunology, virology)