Background Persistent hepatitis E virus (HEV) infection is described in a number of immunosuppressive conditions. We aimed to determine the risk of persistent HEV infection in patients with primary or secondary antibody deficiency. Methods Two hundred forty-five antibody-deficient patients receiving regular immunoglobulin replacement therapy were tested for HEV RNA and anti-HEV immunoglobulin G (IgG). Immunoglobulin products and plasma specimens obtained from 9 antibody-deficient patients before and after intravenous immunoglobulin (IVIG) therapy, 5 recently treated patients with persistent HEV infection, and 5 healthy patients recovered from acute HEV infection were analyzed for anti-HEV IgG and for antibody reacting with HEV antigen. Results No antibody-deficient patient had detectable plasma HEV RNA. Anti-HEV IgG was detected in 38.8% of patients. All 10 immunoglobulin products tested contained anti-HEV capable of neutralizing HEV antigen. Plasma samples collected following IVIG infusion therapy demonstrated a higher anti-HEV IgG level and neutralizing activity, compared with samples collected before IVIG therapy. Neutralizing activity was similar to that in healthy patients with recent acute HEV infection. Conclusion The risk of persistent HEV infection in patients with antibody deficiency appears extremely low. This may be due to passive seroprotection afforded by the ubiquitous presence of anti-HEV in immunoglobulin replacement products.
Bibliographical noteFunding Information:
Financial support. This work was supported by National Health Service Blood and Transplant and Public Health England. Potential conflicts of interest. D. M. L. has received grants from the UCL Biomedical Research Centre and the Rare Diseases Foundation and has received travel and subsistence grants for consultancy work from CSL Behring. S. W. has received travel and subsistence grants from CSL Behring, Octapharma, Grifols, Biotest, BPL, and LFB to attend educational meetings, an educational grant from CSL Behring, and honoraria from LFB and Biotest. M. B. has received consultancy and conference funding from Shire, Biotest, CSL Behring, and Octapharma. A. S. participated in an advisory board for Octapharma and has received conference funding from Grifols and CSL Behring. All other authors report no potential conflicts.
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
- Hepatitis E virus
- antibody deficiency
- chronic infection