Outcome of Hepatitis E Virus Infection in Patients With Inflammatory Arthritides Treated With Immunosuppressants

Abstract

The clinical presentation and outcome of hepatitis E virus (HEV) infection in inflammatory rheumatic diseases are unknown. We aimed to investigate the severity of acute HEV infection and the risk of chronic viral replication in patients with inflammatory arthritides treated with immunosuppressive drugs.All rheumatology and internal medicine practitioners belonging to the Club Rhumatismes et Inflammation in France were sent newsletters asking for reports of HEV infection and inflammatory arthritides. Baseline characteristics of patients and the course of HEV infection were retrospectively assessed by use of a standardized questionnaire.From January 2010 to August 2013, we obtained reports of 23 cases of HEV infection in patients with rheumatoid arthritis (n = 11), axial spondyloarthritis (n = 5), psoriatic arthritis (n = 4), other types of arthritides (n = 3). Patients received methotrexate (n = 16), antitumor necrosis factor α agents (n = 10), rituximab (n = 4), abatacept (n = 2), tocilizumab (n = 2), and corticosteroids (n = 10, median dose 6 mg/d, range 2–20). All had acute hepatitis: median aspartate and alanine aminotransferase levels were 679 and 1300 U/L, respectively. Eleven patients were asymptomatic, 4 had jaundice. The HEV infection diagnosis relied on positive PCR results for HEV RNA (n = 14 patients) or anti-HEV IgM positivity (n = 9). Median follow-up was 29 months (range 3–55). Treatment included discontinuation of immunosuppressants for 20 patients and ribavirin treatment for 5. Liver enzyme levels normalized and immunosuppressant therapy could be reinitiated in all patients. No chronic infection was observed.Acute HEV infection should be considered in patients with inflammatory rheumatism and elevated liver enzyme values. The outcome of HEV infection seems favorable, with no evolution to chronic hepatitis or fulminant liver failure.

Hepatitis E Virus in Industrialized Countries: The Silent Threat

“…However, Senosiain et al [281] found a lower prevalence among patients with inflammatory bowel disease than for the general population. Similarly, Bauer et al [282] studied the HEV infection in patients with inflammatory arthritides under immunosuppressive therapy, but no chronic infection was observed.…”

Hypopituitarism and Hepatitis E Genotype 3 Infection - First Case Report and Review on Immunocompetence in Hypopituitarism

“…This patient had a benign self-limiting course of HEV infection [18]. In a French study, 23 cases of HEV infection in patients with rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, and other types of arthritides under immunosuppressive therapy regimens were studied [19]. The treatment included discontinuation of immunosuppressants in 20 patients and ribavirin treatment in 5 patients.…”

Clinical features and determinants of chronicity in hepatitis E virus infection

“…Chronic HEV infection is almost exclusively reported in immunosuppressed patients. This group includes patients with solid organ transplantation (SOT), patients on chemotherapy for haematologic malignancies, patients infected with HIV and patients with rheumatologic conditions receiving immunomodulatory drugs . Chronic HEV in the SOT population is almost exclusively attributable to genotype 3 infection.…”

“…This group includes patients with solid organ transplantation (SOT), 5 patients on chemotherapy for haematologic malignancies, 7 patients infected with HIV 8 and patients with rheumatologic conditions receiving immunomodulatory drugs. 9 Chronic HEV in the SOT population is almost exclusively attributable to genotype 3 infection. Indeed, chronic infection is not documented with HEV-1 and HEV-2.…”

“…37 Therapy with TNFα inhibitors for rheumatologic conditions has been associated with HEV infection. 9 Though most of these have been acute infections, chronic HEV has been described, despite anti-HEV T-cell responses being preserved, with use of these agents.…”