Hepatitis E in immunocompromised individuals

Abstract

Hepatitis E virus (HEV) originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States. While there are eight identified genotypes to date, genotype 1 (HEV1), HEV2, HEV3, HEV4 are the most common to infect humans. HEV1 and HEV2 are most common in developing countries including Latina America, Africa and Asia, and are commonly transmitted through contaminated water supplies leading to regional outbreaks. In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat. The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing. In majority of cases, HEV infection is a self-limiting hepatitis requiring only symptomatic treatment. However, this is not the case in immunocompromised individuals, including those that have undergone solid organ or stem cell transplantation. In this subset of patients, chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death. The need for re-transplantation as a result of post-transplant hepatitis is of great concern. In addition, there have been many reported incidents of extrahepatic manifestations, for which the exact mechanisms remain to be elucidated. The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies, while attempting to minimize the risk of organ rejection. Subsequent treatment options include ribavirin, and pegylated interferon alpha in those who have demonstrated ribavirin resistance. Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden. Given this concern, vaccination has been approved in China with other investigations underway throughout the world. In this review we introduce the epidemiology, diagnosis, clinical manifestations, and treatment of HEV, with emphasis on immunocompromised individuals in the United States.

Longitudinal analysis of annual national hemovigilance data to assess pathogen reduced platelet transfusion trends during conversion to routine universal clinical use and 7‐day storage

“…Thus, implementation of PR did not adversely impact the incidence of TT HEV. Continued TT HEV is a concern for immunocompromised patients at higher risk of severe clinical outcomes to HEV infection, including fulminant hepatitis, liver fibrosis, and cirrhosis 51,52 . France has implemented HEV screening for plasma donations 50 but does not routinely screen whole blood or apheresis platelet donations for HEV 37 .…”

High occurrence of hepatitis E virus in raw pork liver and pork liver pâté produced in the Canadian province of Quebec

“…Finally, this pilot study provides a glimpse of the potential for contamination with HEV of certain pork liver foods sold commercially in the province of Quebec. It also suggests that monitoring more samples over longer periods is warranted since this virus is now considered an emerging pathogen with potentially severe consequences for growing susceptible populations, such as immunocompromised patients (Damiris et al, 2022) and pregnant women and fetuses (Navaneethan et al, 2008). This research also highlights the continuous presence of HEV in pork liverbased products in Canada over the past 8 years, reinforcing the .…”

Recent Advances in Protective Vaccines against Hepatitis Viruses: A Narrative Review

“…HEV is one of the major infectious causes of acute liver dysfunction, representing a global health problem [ 7 ]. Moreover, HEV infection can cause chronic infection in immunocompromised persons [ 155 ]. Currently, there are eight genotypes of HEV [ 156 ].…”

“…Solid organ transplant patients and persons with other immunosuppressive disorders, such HIV and rheumatological diseases, are more vulnerable to developing chronic HEV infection [ 155 ]. To date, there are no published trials on the use of an HE vaccine in this category of patients.…”