Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients

OBJECTIVES: The prevalence of active, chronic and former hepatitis E virus (HEV) infections in a cohort of immunocompromised patients was investigated, the association with transfusion transmitted (TT) HEV was evaluated, and the HEV seroprevalence was compared with healthy blood donors.

STUDY DESIGN AND METHODS: Serum samples from 4,023 immunocompromised patients at Rigshospitalet, Denmark were retrospectively tested for HEV RNA and anti-HEV IgG. HEV RNA-positive patients were followed up by HEV testing, clinical symptoms and transfusion history. Factors associated with anti-HEV were explored using a multivariable logistic regression analysis. Samples from 1,226 blood donors were retrospectively tested for anti-HEV IgG.

RESULTS: HEV RNA was detected in 6 patients (0.15%) with no indications of chronic HEV infections. HEV RNA prevalence rates among recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT) were 0.58% and 0.21%, respectively. TT-infections were refuted, and transfusion history was not associated with anti-HEV positivity. HEV seroprevalence difference between patients (22.0%) and blood donors (10.9%) waned when adjusting for age and sex (odds ratio 1.20; CI 0.97-1.48).

CONCLUSION: HEV viremia among allo-HSCT and SOT recipients suggests that clinicians should be aware of this diagnosis. No association of blood transfusion with anti-HEV positivity support that food borne transmission is the main transmission route of HEV common to both patients and blood donors.