PLoS ONE (Jan 2014)

Increased HEV seroprevalence in patients with autoimmune hepatitis.

  • 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

DOI
https://doi.org/10.1371/journal.pone.0085330
Journal volume & issue
Vol. 9, no. 1
p. e85330

Abstract

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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.