Mike Ankcorn1,2, Fernando Moreira3, Samreen Ijaz1, Andrew Symes3, Matthew S Buckland3,4, Sarita Workman3, Fiona Warburton5, Richard S Tedder1,2,6, David M Lowe3,4. 1. Blood Borne Virus Unit, Virus Reference Department, Public Health England. 2. Transfusion Microbiology, National Health Service Blood and Transplant. 3. Department of Clinical Immunology, Royal Free London National Health Service Foundation Trust. 4. Institute of Immunity and Transplantation, University College London, Royal Free Campus. 5. Statistics, Modelling, and Economics Department, Public Health England. 6. Division of Infection and Immunity, University College London, London, United Kingdom.
Abstract
Background: Persistent hepatitis E virus (HEV) infection is described in a number of immunosuppressive conditions. We aimed to determine the risk of persistent HEV infection in patients with primary or secondary antibody deficiency. Methods: Two hundred forty-five antibody-deficient patients receiving regular immunoglobulin replacement therapy were tested for HEV RNA and anti-HEV immunoglobulin G (IgG). Immunoglobulin products and plasma specimens obtained from 9 antibody-deficient patients before and after intravenous immunoglobulin (IVIG) therapy, 5 recently treated patients with persistent HEV infection, and 5 healthy patients recovered from acute HEV infection were analyzed for anti-HEV IgG and for antibody reacting with HEV antigen. Results: No antibody-deficient patient had detectable plasma HEV RNA. Anti-HEV IgG was detected in 38.8% of patients. All 10 immunoglobulin products tested contained anti-HEV capable of neutralizing HEV antigen. Plasma samples collected following IVIG infusion therapy demonstrated a higher anti-HEV IgG level and neutralizing activity, compared with samples collected before IVIG therapy. Neutralizing activity was similar to that in healthy patients with recent acute HEV infection. Conclusion: The risk of persistent HEV infection in patients with antibody deficiency appears extremely low. This may be due to passive seroprotection afforded by the ubiquitous presence of anti-HEV in immunoglobulin replacement products.
Background: Persistent hepatitis E virus (HEV) infection is described in a number of immunosuppressive conditions. We aimed to determine the risk of persistent HEV infection in patients with primary or secondary antibody deficiency. Methods: Two hundred forty-five antibody-deficientpatients receiving regular immunoglobulin replacement therapy were tested for HEV RNA and anti-HEV immunoglobulin G (IgG). Immunoglobulin products and plasma specimens obtained from 9 antibody-deficientpatients before and after intravenous immunoglobulin (IVIG) therapy, 5 recently treated patients with persistent HEV infection, and 5 healthy patients recovered from acute HEV infection were analyzed for anti-HEV IgG and for antibody reacting with HEV antigen. Results: No antibody-deficientpatient had detectable plasma HEV RNA. Anti-HEV IgG was detected in 38.8% of patients. All 10 immunoglobulin products tested contained anti-HEV capable of neutralizing HEV antigen. Plasma samples collected following IVIG infusion therapy demonstrated a higher anti-HEV IgG level and neutralizing activity, compared with samples collected before IVIG therapy. Neutralizing activity was similar to that in healthy patients with recent acute HEV infection. Conclusion: The risk of persistent HEV infection in patients with antibody deficiency appears extremely low. This may be due to passive seroprotection afforded by the ubiquitous presence of anti-HEV in immunoglobulin replacement products.
Authors: Michael Ankcorn; Jennifer Gallacher; Samreen Ijaz; Yusri Taha; Heli Harvala; Sheila Maclennan; Emma C Thomson; Chris Davis; Joshua B Singer; Ana da Silva Filipe; Katherine Smollett; Marc Niebel; Malcolm G Semple; Richard S Tedder; Stuart McPherson Journal: J Hepatol Date: 2019-05-08 Impact factor: 25.083
Authors: Anna-Maria Kapsch; Maria R Farcet; Andreas Wieser; Monazza Q Ahmad; Tomoyuki Miyabayashi; Sally A Baylis; Johannes Blümel; Thomas R Kreil Journal: Transfusion Date: 2020-08-13 Impact factor: 3.157