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P859 Hepatitis E seroprevalence in Portuguese inflammatory bowel disease patients under immunosuppression is higher than expected

M. Garrido*1, T. Guedes1, M. Abreu2, I. Pedroto1, P. Lago1

1Centro Hospitalar Universitário do Porto, Gastroenterology, Porto, Portugal, 2Centro Hospitalar Universitário do Porto, Infectious Diseases, Porto, Portugal

Background

Hepatitis E virus (HEV) infection has been recognised over the past decade as an emerging disease. Immunosuppressed patients can develop chronic HEV infection, with the level of immunosuppression determining the clinical course of infection. Inflammatory bowel disease (IBD) patients frequently receive immunosuppressant agents, but the risk of developing chronic HEV infection has not been extensively accessed in this group of patients. Seroprevalence in developed countries is variable with the reported prevalence in portuguese general population being 19.9%. The aim of this study was to determine HEV seroprevalence in patients with IBD undergoing immunosuppression.

Methods

We prospectively tested all consecutive IBD patients referred to the specific Infectious Diseases Prevention in Immunocompromised Patients outpatient clinic of our institution. Anti-HEV-IgG antibodies were detected in serum by commercial enzyme immunoassay (HEV Ab, DiaPro Diagnostic Bioprobes, Milan, Italy), following the manufacturer’s instructions. Level of immunosuppression was defined according to IDSA criteria. Disease activity was defined as a Harvey–Bradshaw Index Score ≥5 or a Total Partial Mayo Index Score ≥2.

Results

A total of 62 patients were included (median age 48.8 years, IQR 39,2–58,6 years; 51.6% male), with a median disease time of 19 years (IQR 13–25 years). The majority were diagnosed with Crohn’s disease (n = 57, 91.9%), the remaining with ulcerative colitis (n = 5, 8.1%). A minority of the patients had active disease (n = 7, 11.3%). Almost half of the patients were treated with combination therapy (n = 28, 45.2%), 22 (35.5%) were under anti-TNF therapy only and 12 (19.4%) on immunomodulator only. Additionally, 2 patients were receiving corticosteroids (prednisolone >20 mg/day). Overall, 51 (82.3%) patients were receiving high-level immunosuppression. Anti-HEV antibodies were positive in 22/62 patients (35.5%), equivocal in 1/62 (1.6%) and negative in 39/62 (62.9%). Although non-significant, anti-HEV positivity increased with the degree of immunosuppression as follows: 3/12 (25%) under immunomodulators, 7/22 (31.8%) under anti-TNF therapy and 12/28 (42.9%) with combination therapy. From the positive anti-HEV patients, only 1 patient had elevated transaminases. There was also no relation between anti-HEV positivity with transaminases elevation or disease activity.

Conclusion

A higher than expected prevalence of anti-HEV antibodies positivity was detected in our institution immunosuppressed IBD patients and, although non-significant, anti-HEV positivity increased with higher levels of immunosuppression.