Original article

Blood Transfusion - 6 2022 (November-December)

Hepatitis E infection in adults with primary immunodeficiency with or without immunoglobulin replacement therapy

Authors

Key words: hepatitis E, primary immunodeficiency, common variable immunodeficiency, immunoglobulin therapy
Publication Date: 2022-02-01

Abstract

Background - In a context of secondary immunodeficiency, hepatitis E virus (HEV) infection can be responsible for chronic liver disease.
Materials and methods - We investigated HEV infection in patients with primary immunodeficiency treated (or not) with immunoglobulin (Ig) replacement therapy (IgRT) in France, a country with a high seroprevalence of HEV. In a nationwide study of individuals with primary immunodeficiency, 533 patients (349 and 184 receiving IgRT or not, respectively) were tested for HEV RNA and anti-HEV antibodies. In addition, 23 batches of five different commercially available immunoglobulin preparations were screened for
anti-HEV IgG.
Results - Three of the 533 patients displayed markers of a recent HEV infection (HEV RNA in one case, and anti-HEV IgG and IgM in two) but no evidence of chronic liver disease. The overall seroprevalence of HEV was 50% (266 out of 533), with values of 68% and 16% in patients receiving IgRT or not, respectively (p<0.001). Anti-HEV IgG were detected in all batches of immunoglobulin preparations, although the titer varied from 3 to 127 IU/g IgG. Seroconversion was observed in 15 of the 22 (68%) patients tested before and after IgRT.
Discussion - No cases of chronic HEV-related disease were detected among patients with primary immunodeficiency and hypogammaglobulinemia, whether they received IgRT or not. This confirms that patients with primary immunodeficiency have a low risk of chronic infection despite a seroprevalence close to that observed in the French general population and that IgRT, which confers a high HEV seroprevalence, might play a key role in protection against chronic infection.

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Authors

Laurence Gérard - Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

Margaux Garzaro - Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, Paris, France

Venicia Ferrer - Department of Virology and INSERM U1043/CNRS 1582, Purpan University Hospital, Toulouse, France

Marion Malphettes - Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

Claire Fieschi - Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, Paris, France

Jean-Luc Garnier - Department of Immunology, Pitié- Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

Nicolas Just - 5Department of Pneumology, Roubaix Hospital, Roubaix, France; Pasteur Institute of Lille, INSERM U1019-UMR 8204-CIIL-Center for Infection and Immunity of Lille, Lille, France

Agathe Masseau - Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France

Constance Delaugerre - University of Paris, Paris, France; Department of Virology and INSERM UMR944, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

Jacques Izopet - Department of Virology and INSERM U1043/CNRS 1582, Purpan University Hospital, Toulouse, France

Eric Oksenhendler - Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; University of Paris, Paris, France

Florence Abravanel - Department of Virology and INSERM U1043/CNRS 1582, Purpan University Hospital, Toulouse, France

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