Prevalence of Hepatitis E Virus Infection in Hemodialysis Patients

Abstract

Background: There are many studies about the epidemiology of hepatitis E virus (HEV) in the general population, but the data about HEV infection among patients with end-stage renal disease (ESRD) give conflicting results. Although the parenteral route may be involved in the transmission of HEV infection, several investigators have suggested that fecal-oral transmission is the primary transmission mode. We aimed to identify the seroprevalence of HEV in hemodialysis (HD) patients compared to the seroprevalence of HBV and HCV infection, and examine the role of parenteral transmission. Methodology: Eighty-four patients from TBRI's HD unit who had been receiving dialysis for more than six months were involved in the study. All the patients were subjected to detailed medical history, full clinical examination, and routine investigations, including virology screening and abdominal ultrasound. HEV seropositivity was investigated by ELISA for HEV-Ab (IgG), while active viremia was assessed by RT-PCR for HEV RNA. Results: Out of the 84 patients, anti-HEV IgG antibodies were detected in five cases (6.0%). A minor (P=0.001) and a moderate (P=0.01) increase in liver echogenicity by ultrasound were significantly correlated with HEV seropositivity. Blood transfusion and HEV seropositivity did not significantly correlate (P=0.6). Neither HBsAg nor HCV-Ab was related to anti-HEV antibody seropositivity. HEV RT-PCR was only positive in one case. Conclusion: Compared to HCV (34.5%), the prevalence of HEV seropositivity was low (6%) in our patients. Parenteral transmission of HEV was less likely. HEV routine screening may help lower the related morbidity and mortality in HD patients.