Background and Aims:
Incidence of autochthonous hepatitis E virus (HEV) infection is reported to increase
in Europe and evolution of chronic hepatitis E has been shown in patients receiving
immunosuppressive treatment after solid organ transplantation. HEV infection may mimic
autoimmune hepatitis or disease flares during immunosuppressive treatment. Aim of
the present study was to investigate the frequency of HEV infection in patients with
AIH.
Methods:
Sera from seventy two consecutive patients with AIH (female: 55 [76.4%], age: 42.2
± 17.5 years [mean ± SD]) in a tertiary referral center were retrospectively analyzed
at baseline and during treatment. All patients were scored as probable or definite
AIH according to the simplified and/or revised scoring system of the IAIHG; prevalence
of anti-HEV-antibodies (Beijing Wantai Biological Pharmacy Enterprises Co., Ltd.)
and HEV RNA was determined.
Results:
19 (26.4%) patients tested positive for HEV-IgG antibodies, which was more than twice
as high as the previously reported sero-prevalence in healthy Austrian individuals
(12.4%). No patient tested positive for HEV-RNA. Seropositive patients were older
(51 ± 12 vs. 39 ± 18 years, [means ± SD], p < 0.01) but did not differ significantly
in AST levels (14.6[1.3 – 121.5] vs. 8.6[0.7 – 84.3], xULN, median[range]), ALT levels
(20.1[1.6 – 62.7] vs. 11[0.8 – 75.7], xULN, median[range]), bilirubin (1.8[0 – 32]
vs. 1.9[0 – 58], mg/dl, median[range]) and IgG-levels (1.3[0.7 – 2.7] vs.1.3[0.6 –
3.8], xULN, median[range]). Seropositivity did not have an effect on treatment response
after 6 or 12 months of immunosuppressive treatment, respectively.
Conclusions:
Seroprevalence of HEV-IgG was found to be high in our cohort with AIH patients suggestive
that HEV infection might be a possible trigger for development of AIH. Testing for
HEV RNA is advisable in patients examined for AIH or not responding to immunosuppressive
treatment.
