mTOR inhibitors a potential predisposing factor for chronic hepatitis E: Results from the prospective collaborative CHES study (Chronic Hepatitis E Screening in patients with immune impairment and increased transaminases levels): Results from the prospective collaborative CHES study (Chronic Hepatitis EScreening in patients with immune impairment and increased transaminases levels)

Mar Riveiro-Barciela, Luisa Roade, Joan Martínez-Camprecios, Judit Vidal-González, Basilio Rodríguez-Diez, Manel Perelló, Guillermo Ortí, Virginia Robles-Alonso, Cristina Berastegui, Jordi Navarro, Fernando Martínez-Valle, Itxarone Bilbao, Lluis Castells, Meritxell Ventura-Cots, Jordi Llaneras, Ariadna Rando-Segura, Xavier Forns, Sabela Lens, Martín Prieto, María García-ElizArkaitz Imaz, Francisco Rodríguez-Frías, Maria Buti*, Rafael Esteban

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Chronic hepatitis E virus (HEV) in persons with immune impairment has a progressive course leading to a rapid progression to liver cirrhosis. However, prospective data on chronic HEV is scarce. The aim of this study was to determine the prevalence and risk factors for chronic HEV infection in subjects with immune dysfunction and elevated liver enzymes. Patients and methods: CHES is a multicenter prospective study that included adults with elevated transaminases values for at least 6 months and any of these conditions: transplant recipients, HIV infection, haemodialysis, liver cirrhosis, and immunosuppressant therapy. Anti-HEV IgG/IgM (Wantai ELISA) and HEV-RNA by an automated highly sensitive assay (Roche diagnostics) were performed in all subjects. In addition, all participants answered an epidemiological survey. Results: Three hundred and eighty-one patients were included: 131 transplant recipients, 115 cirrhosis, 51 HIV-infected subjects, 87 on immunosuppressants, 4 hemodialysis. Overall, 210 subjects were on immunosuppressants. Anti-HEV IgG was found in 94 (25.6%) subjects with similar rates regardless of the cause for immune impairment. HEV-RNA was positive in 6 (1.6%), all of them transplant recipients, yielding a rate of chronic HEV of 5.8% among solid-organ recipients. In the transplant population, only therapy with mTOR inhibitors was independently associated with risk of chronic HEV, whereas also ALT values impacted in the general model. Conclusions: Despite previous abnormal transaminases values, chronic HEV was only observed among solid-organ recipients. In this population, the rate of chronic HEV was 5.8% and only therapy with mTOR inhibitors was independently associated with chronic hepatitis E.

Original languageEnglish
Pages (from-to)764-773
JournalGastroenterologia y Hepatologia
Volume46
Issue number10
DOIs
Publication statusPublished - Dec 2023

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