Epidemiology of Hepatitis E virus in patients with chronic liver disease across South America

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

Boston

Workshop; The Liver Meeting; 2023

AASLD

Background and aims Hepatitis E virus (HEV) is a zoonotic disease frequently associated with self-limited acute hepatitis. Multiple studies have reported that individuals with immunosuppression and/or chronic liver diseases can develop chronic HEV. The epidemiology of the virus is understudied in the Hispanic population. This study aimed to describe the frequency of HEV infection in patients with chronic liver diseases across Latin America.MethodsWe evaluated the presence of IgG anti-HEV (ELISA, Diapro) in 716 serum samples collected from patients in 6 countries of Latin America through the ESCALON network (www.escalon.eu): Argentina (n=162), Brazil (n=54), Chile (n=123), Colombia (n=260), Ecuador (n=61) and Peru (n=56). Causes of chronic liver diseases included: hepatocellular carcinoma (HCC, n=170), cirrhosis (CR, n=387), infection with hepatitis B virus (HBV, n=26) or hepatitis C virus (HCV, n=14) and non-alcoholic fatty liver disease (NAFLD, n=119). ResultsThe mean age of the patients was 62.9 years (range 18-91), 56.4% were male and 43.6% female. The global IgG anti-HEV prevalence in the continent was 16.1% (115/716). Out of this, 38.6% were female (44/114) and 61.4% male (70/114). Specific seropositivity rates by country were: 1.9% (3/162) in Argentina, 14.8% (8/54) in Brazil, 48.8% (60/123) in Chile, 8.5% (22/260) in Colombia, 18% (11/61) in Ecuador and 19.6% (11/56) in Peru. When stratified by liver disease, the prevalence was: 20.1% (78/387) in patients with cirrhosis, 19.4% (33/170) in HCC, 1.7% (2/119) in NAFLD, 3.8% (1/26) in subjects with HBV infection and 7.1% (1/14) in those with HCV infection.ConclusionsThis is the first study addressing HEV in patients with chronic liver disease in multiple countries in Latin America, and the first report overall of HEV among some of the countries, such as Ecuador and Peru. We found a high prevalence of IgG anti-HEV in all groups of patients compared to the general population, particularly in Chile. In depth studies to understand the the implications of this increased sero-epidemiology are needed.