<scp>HEV</scp> in pregnancy: Understanding the crucial role of steroid hormones

Horvatits, Thomas; Pischke, Sven

doi:10.1111/liv.13942

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…On the other hand, these studies include 94,386 female (40%) and male (60%) blood donors, which represent a representative cohort. Sex differences could be related to HEV exposure, such as potentially higher rates of consumption of insufficiently heated pork in men [ 4 , 15 ], hormonal differences affecting the immune system [ 16 ] or socioeconomic factors, and the distribution of different genders in different occupational groups. The increasing HEV PCR positivity rate we observed was caused by European countries only.…”

Section: Discussionmentioning

confidence: 99%

Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

et al. 2023

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Background and aims: The increasing number of diagnosed hepatitis E virus (HEV) infections in Europe has led to the implementation of the testing of blood products in various countries. Many nations have not yet implemented such screening. To assess the need for HEV screening in blood products worldwide, we conducted a systematic review and meta-analysis assessing HEV RNA positivity and anti-HEV seroprevalence in blood donors. Methods: Studies reporting anti-HEV IgG/IgM or HEV RNA positivity rates among blood donors worldwide were identified via predefined search terms in PubMed and Scopus. Estimates were calculated by pooling study data with multivariable linear mixed-effects metaregression analysis. Results: A total of 157 (14%) of 1144 studies were included in the final analysis. The estimated HEV PCR positivity rate ranged from 0.01 to 0.14% worldwide, with strikingly higher rates in Asia (0.14%) and Europe (0.10%) in comparison to North America (0.01%). In line with this, anti-HEV IgG seroprevalence in North America (13%) was lower than that in Europe (19%). Conclusions: Our data demonstrate large regional differences regarding the risk of HEV exposure and blood-borne HEV transmission. Considering the cost–benefit ratio, this supports blood product screening in high endemic areas, such as Europe and Asia, in contrast to low endemic regions, such as the U.S.

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Section: Discussionmentioning

confidence: 99%

Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

et al. 2023

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“…However, hormonal and immunological factors but also genetic factors seem to be of relevance. Steroid hormones which are elevated during pregnancy are known for their immunosuppressive properties and have been reported to enhance viral replication [67,70,71]. Bose et al suggested a link between diminished expression of the progesterone receptor and fatal outcome of hepatitis E in pregnant women [72].…”

Section: Acute Hepatitis Ementioning

confidence: 99%

“…It was furthermore shown that HEV replication occurs in human placenta, and is associated with fetal and maternal mortality in patients with ALF [74]. In summary, multiple hormonal factors seem to influence the clinical course and outcome of HEV infections and thus further studies are needed, investigating the role of genetic HEV variants, hormonal and immunological factors as well as genetic host factors [71].…”

Section: Acute Hepatitis Ementioning

confidence: 99%

The Clinical Perspective on Hepatitis E

Horvatits

Wiesch

Lütgehetmann

et al. 2019

Viruses

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Every year, there are an estimated 20 million hepatitis E virus (HEV) infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. HEV is largely circulating in the west and is associated with several hepatic and extrahepatic diseases. HEV Genotype 1 and 2 infections are waterborne and causative for epidemics in the tropics, while genotype 3 and 4 infections are zoonotic diseases and are mainly transmitted by ingestion of undercooked pork in industrialized nations. The clinical course of these infections differs: genotype 1 and 2 infection can cause acute illness and can lead to acute liver failure (ALF) or acute on chronic liver failure (ACLF) with a high mortality rate of 20% in pregnant women. In contrast, the majority of HEV GT-3 and -4 infections have a clinically asymptomatic course and only rarely lead to acute on chronic liver failure in elderly or patients with underlying liver disease. Immunosuppressed individuals infected with genotype 3 or 4 may develop chronic hepatitis E, which then can lead to life-threatening cirrhosis. Furthermore, several extra-hepatic manifestations affecting various organs have been associated with ongoing or previous HEV infections but the causal link for many of them still needs to be proven. There is no approved specific therapy for the treatment of acute or chronic HEV GT-3 or -4 infections but off-label use of ribavirin has been demonstrated to be safe and effective in the majority of patients. However, in approximately 15% of chronically HEV infected patients, cure is not possible.

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“…Further research is needed to reveal the interactions between various hormones and viruses in the body during pregnancy. [26] HEV may contribute to immunocompromised patients (e.g., solid organ transplant [SOT] patients, [27] patients receiving chemotherapy for hematological malignancies, [28] patients with rheumatism using steroids and other immunosuppressive drugs, [29] and patients with Human Immunodeficiency Virus [HIV] [30] ) develop chronic hepatitis. To date, all chronic infection cases are caused by HEV3 and HEV4, and no related report of HEV1 or HEV2 exists.…”

Section: Clinical Manifestations Diagnosis and Pathologymentioning

confidence: 99%

Promoting development of tertiary hospital by satisfaction surveys

Wang

Deng

2022

Community Acquir Infect

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Hepatitis E virus (HEV) infection is a global health concern, with a large number of new infections reported every year. In developing countries with poor sanitation condition, HEV1 and HEV2 are mainly transmitted by the fecal-oral route due to water contamination. HEV3 and HEV4 are zoonotic diseases in humans consuming undercooked pork, mainly in developed countries. Usually, HEV infection is an acute self-limited course, and chronic infection can occur in immunocompromised individuals. The diagnosis of HEV infection relies on sero - logical tests, including RNA and anti-HEV antibodies. Currently, ribavirin is a proven effective drug; the treatment options for immunocompromised and pregnant individuals are limited. To date, only China has approved vaccines for HEV prevention. Therefore, more research is needed to understand the etiology.

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HEV in pregnancy: Understanding the crucial role of steroid hormones

Abstract: See Article on Page 633

Cited by 6 publications

References 16 publications

Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

Higher Risk of HEV Transmission and Exposure among Blood Donors in Europe and Asia in Comparison to North America: A Meta-Analysis

The Clinical Perspective on Hepatitis E

Promoting development of tertiary hospital by satisfaction surveys

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