Previous hepatitis E virus infection is associated with increased liver stiffness in patients with autoimmune hepatitis

Abstract

Introduction: Autoimmune hepatitis (AIH) is a chronic, progressive liver disease which, in most cases, may require lifelong immunosuppression. Hepatitis E virus (HEV) is a leading cause of acute, typically self-limited, hepatitis worldwide, although immunocompromised patients may develop chronic hepatitis.

Objectives: Here, we evaluated the impact of HEV seropositivity on the clinical course of AIH.

Patients and methods: A group of 374 adult patients with AIH (female 68%, age 34 (18–83) years, 38% with liver cirrhosis) was analyzed. Serum HEV IgG and IgM antibodies were measured by enzyme-linked immunosorbent assay, liver fibrosis was assessed by liver stiffness measurement (LSM), and liver cirrhosis was confirmed with liver histology or LSM.

Results: Fifty-five (15%) patients with AIH were HEV IgG-positive. These patients were older (P <0.001) and had higher BMI and higher LSM (both P <0.05). In a multivariable model including ALT and immunoglobulin G, the HEV seropositive status was associated with an increased risk of advanced liver fibrosis with OR 3.69 (95% CI 1.26–10.77, P = 0.02) as reflected by liver stiffness ≥10.5 kPa. HEV IgG seropositivity was, however, not linked with the type of treatment or worse AIH outcome. The seroprevalence of HEV in patients with AIH was lower compared to results available for Polish blood donors (43%).

Conclusions: Patients with AIH and HEV IgG-positive status seem to be at risk of more advanced liver fibrosis. However, the overall seroprevalence of HEV IgG is a lower in patients with AIH than in the blood donors in Poland.