Absence of Persistent Hepatitis e Virus Infection in Antibody-Deficient Patients Is Associated with Transfer of Antigen-Neutralizing Antibodies from Immunoglobulin Products

Mike Ankcorn*, Fernando Moreira, Samreen Ijaz, Andrew Symes, Matthew S. Buckland, Sarita Workman, Fiona Warburton, Richard Tedder, David M. Lowe

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    7 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)245-253
    Number of pages9
    JournalJournal of Infectious Diseases
    Volume219
    Issue number2
    DOIs
    Publication statusPublished - 7 Jan 2019

    Bibliographical note

    Publisher Copyright:
    © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.

    Keywords

    • Hepatitis E virus
    • IVIG
    • antibody deficiency
    • chronic infection
    • immunoglobulin

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