Prevalência do vírus da hepatite (VHE) em diferentes grupos de pacientes atendidos em serviços ambulatoriais de referência em Salvador-BA

Abstract

Introduction: Hepatitis E virus (HEV) has an extensive worldwide distribution and potential for chronicity in some cases, such as patients with previous liver disease, the immunocompromised, and pregnant women. Furthermore, studies on the epidemiology of HEV infection, especially in these groups of patients, are scarce in Brazil. Objective: To determine the prevalence of HEV in different groups of patients (carriers of hepatitis C virus, hepatitis B virus, autoimmune hepatitis (AIH), patients with drug-induced liver injury, and liver transplant recipients) and to investigate the presence of the HCV-RNA; relation to clinical, sociodemographic, and lifestyle findings. Materials and methods: This is a cross-sectional study. A sample of 301 volunteers from the university referral center for hepatology and 142 liver transplant recipients from the Hepatic Transplantation Unit, both in Bahia. The detection

of anti-HEV IgM and IgG was determined by ELISA for the detection of HEV-RNA, the One- step real-time PCR technique was used. Results: The prevalence of anti-HEV IgG categorized

by groups were: HCV with 13.2%, HBV with 13%, AIH with 8.1%, DILI with 21.1%, and liver transplants with 11.3%. Meanwhile, the seroprevalences for anti HEV IgM were: HCV with

0.9%, HBV with 3.8%, AHI with 0%, DILI with 5.3% and liver transplants with 0.7%. HEV- RNA was not detected among study participants. Patients with chronic hepatitis by HCV and

positive HCV IgG serology showed an increase in transaminases in 66.7% (10/15) of the cases, while the seronegative ones in 42.4% (42/99) of the cases (p<0.05). Grade 3 fibrosis was present in 25% of anti-HEV positive patients and in only 13.5% of anti-HEV negative patients. Among the liver transplant recipients, 50% (8/16) and 37.5% (6/16) of the seropositive cases showed an increase in TGO; and TGO in 25.4% (32/126) and TGP 19.8% (25/125) of seronegative cases. Consumption of game meat was reported by 50% of patients with positive serology and by 32.7% of patients or with negative serology. Contact with swine was reported in 37.5% (6/16) of anti-HEV IgG positive liver transplants and in 0.8% (1/126) of anti-HEV IgG negative (p<0.05). Conclusions: The prevalence of anti-HEV IgG among the different groups of patients was high. Acute infection was observed through positive results for anti HEV IgG/IgM concomitantly, associated with high levels of TGO/TGP. Transaminases were increased more commonly in HEV seropositive patients and, in addition, clinical and biochemical parameters showed a worse prognosis among those infected with HEV. Our data indicate the need for further studies to investigate the clinical and biochemical parameters associated with HEV infection, as well as to understand the presence of HEV in domestic and wild animals and thus contribute to the understanding of the epidemiology of HEV in our environment.