Prevalence of Hepatitis E Virus in Patients with Chronic Hepatopathy in a Reference Center of Bahia State, Brazil

Main Article Content

Gisele B L Menezes Delvone Almeida Sidelcina Rugieri Pacheco Maurício Souza Campos Michele Gomes Gouvea Joao Renato Rebello Pinho Roberto Meyer Nascimento Songeli Menezes Freire Robert Schaer Maria Isabel Schinoni

Abstract

Introduction: Hepatitis E virus infection can lead to severe liver disease and unregulated hepatitis in patients with a history of previous chronic liver disease of different etiologies.


Objective: To determine the seroprevalence of hepatitis E in untreated carriers of hepatitis C virus, hepatitis B virus, autoimmune hepatitis and in patients with drug-induced liver disease.


Materials and Methods: This is a cross-sectional study with a total sample of 301 outpatient hepatology volunteers. The detection of anti-HEV IgM and IgG antibodies was determined using the ELISA (RecomWell anti-HEV IgG and IgM, Mikrogen®, Germany), One-step real-time PCR was used for the detection of HEV-RNA (Taqman, Life Technologies TM, Foster City, CA, USA).


Results: The overall prevalence of anti-HEV IgG and IgM in the population studied was 12.95% and 2.3%, respectively. The prevalence by group were: anti-HEV IgG: hepatitis C virus with 13.2%, hepatitis B virus with 13%, autoimmune hepatitis with 8.1 and drug-induced liver disease with 21.1. Patients with HCV chronic hepatitis and positive HCV IgG serology showed an increase in transaminase levels in 66.7% (10/15) of the cases, while in the seronegative patients this increase was present in 42.4% (42/99) of the cases (p<0.05).


Conclusions: A high seroprevalence of HEV was observed. Among the patients with serology concomitantly positive for anti HEV IgG and IgM, 57.1% (4/7) had higher levels of TGO and TGP, suggesting acute HEV infection. A relationship between hepatitis C and E virus co-infection and elevated transaminase levels has been demonstrated. Future studies with evaluation of several clinical parameters are necessary.

Keywords: Hepatitis E, Hepatitis B, Hepatitis C, Drug-induced liver disease, Autoimmune hepatitis

Article Details

How to Cite
MENEZES, Gisele B L et al. Prevalence of Hepatitis E Virus in Patients with Chronic Hepatopathy in a Reference Center of Bahia State, Brazil. Medical Research Archives, [S.l.], v. 11, n. 5, may 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3773>. Date accessed: 03 oct. 2024. doi: https://doi.org/10.18103/mra.v11i5.3773.
Section
Research Articles

References

1 Colson P, Dhiver C, Gérolami R. Hepatitis E virus as a newly identified cause of acute viral hepatitis during human immunodeficiency virus infection. Clin Microbiol Infect. 2008; 14:1176-80. https://doi.org/10.1111/j.1469-0691.2008.02102.xE
2 World Health Organization Global Hepatitis Report,
http://www.who.int/mediacentre/factsheets/fs280/en ; 2017 [accessed 06 Dec 2021].
3 Souza AJS, Oliveira CMA, Sarmento VP, et al. Hepatitis E virus infection among rural Afro-descendant communities from the eastern Brazilian Amazon. Rev Soc Bras Med Trop. 2018; 51:803-807. https://doi.org/10.1590/0037-8682-0394-2017
4 Hering T, Passos AM, Perez RM, et al. Past and current hepatitis E virus infection in renal transplant patients. J. Med. Virol. 2014; 86:948–953. https://doi.org/10.1002/jmv.23915
5 Passos-Castilho AM, de Sena A, Geraldo A, Spada C, Granato CF. High prevalence of hepatitis E virus antibodies among blood donors in Southern Brazil. J. Med. Virol. 2016; 88:361–364. https://doi.org/10.1002/jmv.24336.
6 Bricks G, Senise JF, Pott H Jr, et al. Seroprevalence of hepatitis E virus in chronic hepatitis C in Brazil. Braz J Infect Dis, 2018; 22:85-91. https://doi.org/10.1016/j.bjid.2018.02.001
7 Bricks G, Senise JF, Pott-Jr H, et al. Previous hepatitis E virus infection, cirrhosis and insulin resistance in patients with chronic hepatitis C. Braz. J. Infect. Dis. 2019; 23:45–52. https://doi.org/10.1016/j.bjid.2019.02.002
8 Castro VOL, Tejada-Strop A, Weis SMS, et al. Evidence of hepatitis E virus infections among persons who use crack cocaine from the Midwest region of Brazil. J. Med. Virol. 2019; 91:151–154. https://doi.org/10.1002/jmv.25288
9 Kumar AS, Kumar SP, Singh R, et al. Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death. J Hepatol, 2007; 46:387-394. https://doi.org/10.1016/j.jhep.2006.09.016
10 Vento S. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. J Viral Hepat.2000; 7:7-8. https://doi.org/10.1046/j.1365-2893.2000.00019.x
11 Sagnelli NE e Coppola V M, et al. HBV superinfection in hepatitis C virus chronic carriers, viral interaction, and clinical course. Hepatology, 2002; 36:1285-1291. https://doi.org/10.1053/jhep.2002.36509
12 Costa MB, Gouvêa MSG, Chuffi S, et al. Seroprevalence of hepatitis E virus in risk populations and blood donors in a referral hospital in the south of Brazil. Sci Rep. 2021; 16:6011. https://doi.org/10.1038/s41598-021-85365-5
13 Hardtke S, Rocco R, Ogata J, et al. Risk factors and seroprevalence of hepatitis E evaluated in frozen-serum samples (2002–2003) of pregnant women compared with female blood donors in a Southern region of Brazil. J. Med. Virol. 2018; 90:1856–1862. https://doi.org/10.1002/jmv.25274
14 Kiesslich D, Rocha JE Jr e Crispim MA. Prevalence of hepatitis E virus antibodies among different groups in the Amazonian basin. Transactions of the Royal Society of Tropical Medicine and hygiene. 2002; 96:215 https://doi.org/10.1016/S0035-9203(02)90311-1
15 Purdy MA, Khudyakov YE. The molecular epidemiology of hepatitis E virus infection. Virus Res. 2011;161:319. https://doi.org/10.1016/j.virusres.2011.04.030
16 Pischke S, Behrendt P, Bock CT, Jilg W, Manns MP, Wedemeyer H. Hepatitis E in Germany--an under-reported infectious disease. Dtsch Arztebl Int. 2014; 111: 577-83. https://doi.org/10.3238/arztebl.2014.0577
17 Kaene F, Gompels M, Bendall R, et al. Hepatitis E virus coinfection in patients with HIV infection. HIV Med. 2012; 13:83-8. https://doi.org/10.1111/j.1468-1293.2011.00942.x
18 Junge N, Pischke S, Baumann U, Goldschmidt I, Manns M, Wedemeyer H, et al. Results of single-center screening for chronic hepatitis e in children after liver transplantation and report on successful treatment with ribavirin. Pediatr Transplant. 2013; 17:343–7. https://doi.org/10.1111/petr.12077
19 De Niet A, Zaaijer HL, Ten Berge I, Weegink CJ, Reesink HW, Beuers U. Chronic hepatitis E after solid organ transplantation. Neth J Med. 2012; 70:261–6. PMID: 22859417.
20 Calisti G, Irish D, Ijaz S, Tedder R, Moore K. Acute hepatitis E mimicking a flare of disease in a patient with chronic autoimmune hepatitis. Ann Hepatol. 2017; 16:160163. https://doi.org/10.5604/16652681.1226952
21 Jothikumar N, Cromeans TL, Robertson BH, Meng XJ, Hill VR. A broadly reactive one-step real-time RT-PCR assay for rapid and sensitive detection of hepatitis E virus. J Virol Methods. 2006; 131:65-71. https://doi.org/10.1016/j.jviromet.2005.07.004
22 de Moraes ACP, Gouvea MG, Ferreira AC, et al. The impact of hepatitis E infection on hepatic fibrosis in liver transplanted patients for hepatitis C infection. Braz J Infect Dis. 2021; 25(3):101587. https://doi.org/10.1016/j.bjid.2021.101587
23 Tengan FM, Figueiredo GM, Nunes AKS, et al. Seroprevalence of hepatitis E in adults in Brazil: a systematic review and meta-analysis. Infect Dis Poverty.2019; 8:3. https://doi.org/10.1186/s40249-018-0514-4
24 Trinta KS, Liberto MI, de Paula VS, Yoshida CF, Gaspar AM. Hepatitis E virus infection in selected Brazilian populations. Mem Inst Oswaldo Cruz. 2001; 96:25–9. https://doi.org/10.1590/s0074-02762001000100004
25 Parana R, Cotrim HP, Cortey-Boennec ML, Trepo C, Lyra L. Prevalence of hepatitis E virus IgG antibodies in patients from a referral unit of liver diseases in Salvador, Bahia, Brazil. Am J Trop Med Hyg. 1997; 57:60–1. https://doi.org/10.4269/ajtmh.1997.57.60
26 Ferreira AC, Gomes-Gouvea MS, Lisboa-Neto G, et al. Serological and molecular markers of hepatitis E virus infection in HIV-infected patients in Brazil. Arch Virol. 2018; 163:43–9. https://doi.org/10.1007/s00705-017-3562-3
27 de Oliveira J, Freitas NR, Teles SA, et al. Prevalence of hepatitis E virus RNA and antibodies in a cohort of kidney transplant recipients in Central Brazil. Int J Infect Dis. 2018; 69:41–3. https://doi.org/10.1016/j.ijid.2018.01.032
28 Bortoliero AL, Bonametti AM, Morimoto HK, Matsuo T, Reiche EM. Seroprevalence for hepatitis E virus (HEV) infection among volunteer blood donors of the Regional Blood Bank of Londrina, State of Paraná, Brazil. Rev Inst Med Trop Sao Paulo. 2006; 48:87-92. https://doi.org/10.1590/S0036-46652006000200006.
29 Passos-Castilho, A M, Reinaldo, M R, Sena, A G, Celso F.H. High prevalence of hepatitis E virus antibodies in Sao Paulo, Southeastern Brazil: analysis of a group of blood donors representative of the general population. The Brazilian Journal of Infectious Diseases. 2017; 21:535-539 https://doi.org/10.1016/j.bjid.2017.05.004
30 Bezerra LA, de Oliveira-Filho EF, Silva JVJ Jr, Santos Morais VM, Gonçales JP, da Silva DM, Duarte Coêlho MRC. Risk analysis and seroprevalence of HEV in people living with HIV/AIDS in Brazil. Acta Trop. 2019; 189:65-68. https://doi.org/10.1016/j.actatropica.2018.09.026
31 Santos DC, Souto FJ, Santos DR, Vitral CL, Gaspar AM. Seroepidemiological markers of enterically transmitted viral hepatitis A and E in individuals living in a community located in the North Area of Rio de Janeiro, RJ, Brazil. Mem Inst Oswaldo Cruz. 2002; 97:637-40. https://doi.org/10.1590/S0074-02762002000500007
32 Passos-Castilho AM, de Sena A, Reinaldo MR, Granato CF. Hepatitis E virus infection in Brazil: results of laboratory-based surveillance from 1998 to 2013. Rev Soc Bras Med Trop. 2015; 48:468-70. https://doi.org/10.1590/0037-8682-0036-2015
33 Vitral CL, da Silva-Nunes M, Pinto MA, et al. Hepatitis A and E seroprevalence and associated risk factors: a community-based cross-sectional survey in rural Amazonia. BMC Infect Dis. 2014; 14:458. https://doi.org/10.1186/1471-2334-14-458
34 Huang S, Zhang X, Jiang H, et al. Profile of acute infectious markers in sporadic hepatitis E. PLoS One. 2010; 5:13560. https://doi.org/10.1371/journal.pone.0013560.
35 Aggarwal R. Diagnosis of hepatitis E. Nat Rev Gastroenterol Hepatol. 2013;10:24-33. https://doi.org/10.1038/nrgastro.2012.187.
36 Dalton HR, Kamar N, Baylis SA, Moradpour D, Wedemeyer H, Negro F. EASL Clinical practice guidelines on hepatitis E virus infection. J Hepatol. 2018; 68:1256-71. https://doi.org/10.1016/j.jhep.2018.03.005
37 Elhendawy M, Abo-Ali L, Abd-Elsalam S, et al. HCV and HEV: two players in an Egyptian village, a study of prevalence, incidence, and co-infection. Environ Sci Pollut Res Int. 2020; 27:33659-33667. https://doi.org/10.1007/s11356-020-09591-6.
38 Bayram A, Eksi F, Mehli M, Sözen E. Prevalence of hepatitis E virus antibodies in patients with chronic hepatitis B and chronic hepatitis C. Intervirology. 2007; 50:281-6. https://doi.org/10.1159/000103916.
39 Payne BA, Medhi M, Ijaz S, et al. Hepatitis E virus seroprevalence among men who have sex with men, United Kingdom. Emerg Infect Dis. 2013; 19:333-5. https://doi.org/10.3201/eid1902.121174.
40 Colson P, Borentain P, Queyriaux B, et al. Pig liver sausage as a source of hepatitis E virus transmission to humans. The Journal of Infectious Diseases.2010; 202:825–834. https://doi.org/10.1086/655898
41 Legrand-Abravanel F, Kamar N, Sandres-Saune K, et al. Characteristics of autochthonous hepatitis E virus infection in solid-organ transplant recipients in France. The Journal of infectious diseases. 2010; 202:835–844. https://doi.org/10.1086/655899
42 Arnaboldi S, Righi F, Carta V, et al. Hepatitis E Virus (HEV) Spread and Genetic Diversity in Game Animals in Northern Italy. Food Environ Virol. 2021; 13:146-153. https://doi.org/10.1007/s12560-021-09467-z.
43 Abravanel F, Lhomme S, El Costa H, et al. Rabbit hepatitis E virus infections in humans, France. Emerging Infectious Diseases.2017; 23:1191–1193. https://doi.org/10.3201/eid2307.170318
44 Arankalle VA, Chadha MS, & Chobe LP. Long-term serological follow up and cross-challenge studies in rhesus monkeys experimentally infected with hepatitis E virus. Journal of Hepatology, 1999; 30:199–204. https://doi.org/10.1016/S0168-8278(99)80062-2
45 Kukielka D, Rodriguez-Prieto V, Vicente J, & Sánchez-Vizcaíno J. Constant hepatitis E virus (HEV) circulation in wild boar and red deer in Spain: an increasing concern source of HEV zoonotic transmission. Transboundary and Emerging Diseases. 2016; 63:360–368. https://doi.org/10.1111/tbed.12311.
46 Treagus S, Wright C, Baker-Austin C, Longdon B, Lowther J. The Foodborne Transmission of Hepatitis E Virus to Humans. Food Environ Virol. 2021; 13:127-145. https://doi.org/10.1007/s12560-021-09461-5
47 Kamar N, Izopet J, Pavio N, et al. Hepatitis E virus infection. Nat Rev Dis Primers. 2017; 16:17086. https://doi.org/10.1128/CMR.00057-13