HEPATITIS-E VIRUS-INFECTION IN A COHORT OF PATIENTS WITH ACUTE NON-A,NON-B-HEPATITIS

Background/Aims: The aim of this study was to determine the frequency of hepatitis E virus infection in a cohort of patients with acute non- A, non-B hepatitis in Greece. Methods: Serial serum samples of 198 pat ients with acute non-A, non-B hepatitis and a single serum specimen fr om 316 healthy subjects were tested for IgG and IgM antibodies to hepa titis E virus (anti-HEV). Results: Anti-HEV IgG was found in 15/198 (7 .6%) of acute non-A, non-B hepatitis patients and 7/316 (2.2%) of heal thy controls (p=0.007). Anti-HEV IgM was found in 2/198 (1.0%) acute n on-A, non-B hepatitis patients and in none of the healthy subjects. Ne ither anti-HEV IgM (+) case reported any risk factor and neither had t ravelled in areas endemic for hepatitis E virus infection. HEV-RNA was detected by reverse transcription polymerase chain reaction in one pa tient. The prevalence of anti-HEV IgG was 7/45 (15.6%), 1/46 (2.2%), 5 /30 (16.7%) and 2/77 (2.6%) in acute non-A, non-B hepatitis reporting transfusion, intravenous drug use, occupational/hospitalization, and u nknown transmission, respectively (p=0.007). Anti-HEV IgG was found in 13/122 (10.7%) and 2/76 (2.6%) of acute non-A, non-B hepatitis patien ts positive and negative for anti-HCV: respectively (p=0.03). A simila r association was found with anti-HBc (p=0.007). The prevalence of ant i-HEV IgG was significantly higher in cases reporting transfusion [OR= 7.3, 95% C.I. 1.4-37.7, p=0.0171 and occupational/hospitalization [OR= 6.8, 95% C.I. 1.238.2, p=0.0291, as transmission category after contro lling for age. Conclusions: These findings indicate that: (a) hepatiti s E virus may be a cause - although not a frequent one - of sporadic o r community-acquired acute non-A, non-B hepatitis in Greece; (b) hepat itis E virus may share transmission routes with hepatitis B and C viru ses; and (c) the hypothesis that hepatitis E virus may be transmitted by parenteral routes deserves careful consideration.