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Hepatitis E Virus Species C Infection in Humans, Hong Kong

2021; Oxford University Press; Volume: 75; Issue: 2 Linguagem: Inglês

10.1093/cid/ciab919

1537-6591

Siddharth Sridhar, Cyril Chik Yan Yip, Kelvin Hon Yin Lo, Shusheng Wu, Jianwen Situ, Nicholas Foo‐Siong Chew, Kit Hang Leung, Helen Shuk Ying Chan, Sally Cheuk Ying Wong, Anthony Wai Shing Leung, Cindy Wing Sze Tse, Kitty S. C. Fung, O. T. Y. Tsang, Kam‐Lun Ellis Hon, Vincent Chi‐Chung Cheng, Ken Ho Leung Ng, Kwok Yung Yuen,

Employment and Welfare Studies

Hepatitis E virus (HEV) variants belonging to Orthohepevirus species A (HEV-A) are the primary cause of human hepatitis E. However, we previously reported that Orthohepevirus species C genotype 1 (HEV-C1), a divergent HEV variant commonly found in rats, also causes hepatitis in humans. Here, we present a clinical-epidemiological investigation of human HEV-C1 infections detected in Hong Kong, with an emphasis on outcomes in immunocompromised individuals.A surveillance system for detecting human HEV-C1 infections was established in Hong Kong. Epidemiological and clinical characteristics of HEV-C1 cases identified via this system between 1 August 2019 and 31 December 2020 were retrieved. Phylogenetic analysis of HEV-C1 strain sequences was performed. Infection outcomes of immunocompromised individuals with HEV-A and HEV-C1 infections were analyzed.HEV-C1 accounted for 8 of 53 (15.1%) reverse-transcription polymerase chain reaction (RT-PCR)-confirmed HEV infections in Hong Kong during the study period, raising the total number of HEV-C1 infections detected in the city to 16. Two distinct HEV-C1 strain groups caused human infections. Patients were elderly and/or immunocompromised; half tested negative for HEV immunoglobulin M. Cumulatively, HEV-C1 accounted for 9 of 21 (42.9%) cases of hepatitis E recorded in immunocompromised patients in Hong Kong. Immunocompromised HEV-C1 patients progressed to persistent hepatitis at similar rates (7/9 [77.8%]) as HEV-A patients (10/12 [75%]). HEV-C1 patients responded to oral ribavirin, although response to first course was sometimes poor or delayed.Dedicated RT-PCR-based surveillance detected human HEV-C1 cases that evade conventional hepatitis E diagnostic testing. Immunosuppressed HEV-C1-infected patients frequently progress to persistent HEV-C1 infection, for which ribavirin is a suitable treatment option.