1. Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study.
- Author
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Pischke S, Peron JM, von Wulffen M, von Felden J, Höner Zu Siederdissen C, Fournier S, Lütgehetmann M, Iking-Konert C, Bettinger D, Par G, Thimme R, Cantagrel A, Lohse AW, Wedemeyer H, de Man R, and Mallet V
- Subjects
- Adult, Aged, Antiviral Agents therapeutic use, Arthritis complications, Europe, Female, Hepatitis E drug therapy, Hepatitis, Chronic drug therapy, Humans, Immunocompromised Host, Immunosuppression Therapy, Internal Medicine, Male, Methotrexate adverse effects, Methotrexate therapeutic use, Middle Aged, RNA, Viral, Recurrence, Retrospective Studies, Rheumatology, Ribavirin therapeutic use, Risk Factors, Arthritis virology, Hepatitis E etiology, Hepatitis, Chronic etiology
- Abstract
Objectives: Hepatitis E virus (HEV) infection is a pandemic with regional outbreaks, including in industrialized countries. HEV infection is usually self-limiting but can progress to chronic hepatitis E in transplant recipients and HIV-infected patients. Whether other immunocompromised hosts, including rheumatology and internal medicine patients, are at risk of developing chronic HEV infection is unclear. Methods: We conducted a retrospective European multicenter cohort study involving 21 rheumatology and internal medicine patients with HEV infection between April 2014 and April 2016. The underlying diseases included rheumatoid arthritis ( n = 5), psoriatic arthritis ( n = 4), other variants of chronic arthritis ( n = 4), primary immunodeficiency ( n = 3), systemic granulomatosis ( n = 2), lupus erythematosus ( n = 1), Erdheim⁻Chester disease ( n = 1), and retroperitoneal fibrosis ( n = 1). Results: HEV infection lasting longer than 3 months was observed in seven (33%) patients, including two (40%) patients with rheumatoid arthritis, three (100%) patients with primary immunodeficiency, one (100%) patient with retroperitoneal fibrosis and one (100%) patient with systemic granulomatosis. Patients with HEV infection lasting longer than 3 months were treated with methotrexate without corticosteroids ( n = 2), mycophenolate mofetil/prednisone ( n = 1), and sirolimus/prednisone ( n = 1). Overall, 8/21 (38%) and 11/21 (52%) patients cleared HEV with and without ribavirin treatment, respectively. One patient experienced an HEV relapse after initially successful ribavirin therapy. One patient (5%) was lost to follow-up, and no patients died from hepatic complications. Conclusion: Rheumatology and internal medicine patients, including patients treated with methotrexate without corticosteroids, are at risk of developing chronic HEV infection. Rheumatology and internal medicine patients with abnormal liver tests should be screened for HEV infection.
- Published
- 2019
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