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Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

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Nicole M.F. van Gerven1, Annemiek A. van der Eijk2, Suzan D. Pas2, Hans L. Zaaijer3, Ynto S. de Boer1, Birgit I. Witte4, Carin M.J. van Nieuwkerk1, Chris J.J. Mulder1, Gerd Bouma1, Robert A. de Man5
On behalf of the Dutch Autoimmune Hepatitis Study Group*

1) Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam
2) Department of Virology, Erasmus Medical Centre, Rotterdam
3) Department of Blood-borne infections, Sanquin Blood Supply Foundation, Amsterdam
4) Department of Epidemiology and Biostatistics, VU University Medical Centre,
5) Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam
The Netherlands

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.251.hpe


Background & Aims: In recent years chronic courses of hepatitis E virus (HEV) infection have been described in immunosuppressed individuals. This may implicate a potential role for HEV in the development of autoimmune diseases, including autoimmune hepatitis (AIH). Here we investigated the prevalence of HEV-antibodies in AIH patients in an endemic Central European country.

Methods: HEV-specific immunoglobulin G (IgG) and HEV RNA were determined in 354 and 377 AIH patients, respectively. Clinical characteristics and disease outcome parameters were retrospectively collected.

Results: No HEV viraemic patients were identified in this cohort. A total of 106 AIH patients (29.9%) tested positive for anti-HEV IgG, and this figure was slightly higher compared to the prevalence in a reference cohort including 5,329 healthy Dutch blood donors (26.7%; P>0.05).

Conclusion: This is the largest study on the association between HEV infection and AIH. Apparently silent HEV infection is present in a significant proportion of AIH patients, yet appears not to have significant clinical repercussions in this immune compromised group of patients. Nevertheless, since acute hepatitis E may present with histological and biochemical features of AIH, the possibility of a (concomitant) HEV infection should be considered in this category of patients.

Key words: hepatitis E virus infection – autoimmune hepatitis – anti-HEV IgG – prevalence.
Abbreviations: AIH: autoimmune hepatitis; ALT: alanine aminotransferase; SMA: anti smooth muscle antibodies; ANA: antinuclear antibodies; PBC: primary biliary cirrhosis; AMA: anti mitochondrial antibodies; PSC: primary sclerosing cholangitis.