Hepatitis E virus in South America: infection in patients with chronic liver diseases

PISANO MB, ; FANTILLI AC, BALDERRAMO DC, PRIETO JE, ARRESE M, CARRERA E, DÍAZ FERRER J, MATTOS A, ; RÉ V,; BOONSTRA A; DEBES J

Simposio; 2nd International HEV Symposium, IVI ? International Vaccine Institute; 2023

Presenting autor: María Belén PisanoInstituto de Virología “Dr. Vanella”, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba.Argentinambelenpisano@gmail.com; belen.pisano@unc.edu.arCo-authors׳ affiliation details (institution & country only).Title: Hepatitis E virus in South America: infection in patients with chronic liver diseases.Pisano MB, Fantilli AC, Balderramo DC, Prieto JE, Arrese M, Carrera E, Díaz Ferrer J, Mattos A, Ré VE, Boonstra A, Debes JD. Background and aims Hepatitis E virus (HEV) is a zoonotic enteric-transmitted single-stranded RNA virus, frequently associated with self-limited acute hepatitis. Multiple studies have reported that individuals with immunosuppression and/or chronic liver diseases can develop chronic hepatitis and have higher HEV seroprevalence rates compared to the general population. Chronic cases have mostly been observed due to HEV-3. In South America, HEV-3 has been detected in humans, animals (pigs, wild boards) and environmental samples. However, it is still an understudied virus and clinical cases are not usually investigated and reported. The objective of the work was to describe the frequency of HEV infection and associated causes in patients with chronic liver diseases from South America.MethodsWe studied presence of IgG anti-HEV (ELISA, Diapro) in 597 serum samples collected from patients with chronic liver diseases during 2020-2022 from South American countries: Argentina (n=162), Brazil (n=54), Chile (n=126), Colombia (n=138) Ecuador (n=61) and Peru (n=56). Causes of chronic liver diseases included: hepatocellular carcinoma (HCC, n=169), cirrhosis (CR, n=349), infection with hepatitis B virus (HBV, n=26) or hepatitis C virus (HCV, n=14) and non-alcoholic fatty liver disease (NAFLD, n=39). ResultsThe global IgG anti-HEV prevalence was 19.1% (114/597). According to the causes of liver disease, the prevalences were: 22.9% (80/349) in patients with CR, 18.9% (32/169) in individuals with HCC, 0% (0/39) in patients presenting NAFLD, 3.9% (1/26) in subjects with HBV infection and 7.1% (1/14) in those with HCV infection (Figure 1). ConclusionsThis is the first study on HEV in patients with liver disease involving several South American countries, and even the first report in some of them. We found a high prevalence of IgG anti-HEV in all groups of patients in almost all countries, particularly in Chile, which highlights the need to increase the diagnosis of this virus in these patients, who could develop more severe infections (due to the underlying liver disease). An association between HEV infection and liver cirrhosis has been reported in several studies; our results showed that patients with CR presented the highest prevalence in all regions, consistent with these previous reports. More studies are needed to elucidate the role of HEV in this population, as well as to make the virus known to the health team and reduce underdiagnosis.