Turkish Journal of Gastroenterology
Original Article

Hepatitis E Virus Prevalence and Associated Risk Factors in High-Risk Groups: A Cross-Sectional Study

1.

Division of Gastroenterology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey

2.

Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey

3.

Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey

4.

Department of Biostatistics, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey

5.

Division of Nephrology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey

6.

Division of Hematology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, Turkey

Turk J Gastroenterol 2022; 33: 615-624
DOI: 10.5152/tjg.2022.21493
Read: 308 Downloads: 100 Published: 01 July 2022

Background: Seroepidemiology, risk factors to hepatitis E virus exposure, and prevalence of hepatitis E virus viremia have not yet been investigated among patients under immunosuppression or with liver disease that are high risk for infection in Turkey.

Methods: In this cross-sectional study, 292 consecutive serum samples from renal transplant recipients, allogeneic hematopoietic stem cell transplant recipients, patients with acute hepatitis, and patients with chronic hepatitis C were prospectively collected in a ter- tiary university hospital. Sera were tested for hepatitis E virus immunoglobulin G/immunoglobulin M and hepatitis E virus ribonucleic acid using commercial enzyme-linked immunosorbent assay and in-house nested polymerase chain reaction with Sanger sequencing, respectively. Sociodemographic, clinical, laboratory data, and risk factors were collected using a questionnaire and hospital database. Multiple logistic regression analysis was employed to identify independent predictors for anti-hepatitis E virus seropositivity.

Results: Among all patients, only 2 patients (1 renal transplant recipient and 1 patient with acute hepatitis) were identified as having hepatitis E virus genotype 3 viremia. Hepatitis E virus viremia rate was 0.6% in whole group. These patients showed no signs of chronic hepatitis E virus infection for 6 months and were spontaneously seroconverted 6 months after enrollment. Anti-hepatitis E virus IgG was positive in 29 patients yielding a hepatitis E virus seroprevalence of 9.9%. Older age (adjusted odds ratio: 1.03, 95% CI, 1.00-1.06; P = .022) and eating undercooked meat (adjusted odds ratio: 3.11, 95% CI, 1.08-8.92; P = .034) were independent risk factors to anti- hepatitis E virus seropositivity in all patients. Similarly, multiple logistic regression analysis demonstrated that age (adjusted odds ratio: 1.03, 95% CI, 0.99-1.07, P = .058) and eating undercooked meat (adjusted odds ratio: 5.77, 95% CI, 1.49-22.25, P = .011) were indepen- dent risk factors for anti-hepatitis E virus IgG positivity in the liver disease subgroup consisting of acute hepatitis and chronic hepatitis C patients.

Conclusion: The hepatitis E virus seroprevalence rate was high (9.9%), despite low viremia rate (0.6%) in high-risk patients. The emer- gence of hepatitis E virus genotype 3 might indicate a serious problem for these patients. Future investigations are needed to elucidate foodborne transmission routes of hepatitis E virus in Turkey.

Cite this article as: Balaban HY, Aslan AT, Akdoğan-Kittana FN, et al. Hepatitis E virus prevalence and associated risk factors in high-risk groups: A cross-sectional study. Turk J Gastroenterol. 2022;33(7):615-624.

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