Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study
<b>Objectives:</b> Hepatitis E virus (HEV) infection is a pandemic with regional outbreaks, including in industrialized countries. HEV infection is usually self-limiting but can progress to chronic hepatitis E in transplant recipients and HIV-infected patients. Whether other immunocompro...
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MDPI AG
2019-02-01
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Online Access: | https://www.mdpi.com/1999-4915/11/2/186 |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sven Pischke Jean-Marie Peron Moritz von Wulffen Johann von Felden Christoph Höner zu Siederdissen Sophie Fournier Marc Lütgehetmann Christoph Iking-Konert Dominik Bettinger Gabriella Par Robert Thimme Alain Cantagrel Ansgar W. Lohse Heiner Wedemeyer Robert de Man Vincent Mallet |
spellingShingle |
Sven Pischke Jean-Marie Peron Moritz von Wulffen Johann von Felden Christoph Höner zu Siederdissen Sophie Fournier Marc Lütgehetmann Christoph Iking-Konert Dominik Bettinger Gabriella Par Robert Thimme Alain Cantagrel Ansgar W. Lohse Heiner Wedemeyer Robert de Man Vincent Mallet Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study Viruses hepatitis E chronic hepatitis E disease-modifying antirheumatic drugs (DMARDs) ribavirin |
author_facet |
Sven Pischke Jean-Marie Peron Moritz von Wulffen Johann von Felden Christoph Höner zu Siederdissen Sophie Fournier Marc Lütgehetmann Christoph Iking-Konert Dominik Bettinger Gabriella Par Robert Thimme Alain Cantagrel Ansgar W. Lohse Heiner Wedemeyer Robert de Man Vincent Mallet |
author_sort |
Sven Pischke |
title |
Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study |
title_short |
Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study |
title_full |
Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study |
title_fullStr |
Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study |
title_full_unstemmed |
Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort Study |
title_sort |
chronic hepatitis e in rheumatology and internal medicine patients: a retrospective multicenter european cohort study |
publisher |
MDPI AG |
series |
Viruses |
issn |
1999-4915 |
publishDate |
2019-02-01 |
description |
<b>Objectives:</b> Hepatitis E virus (HEV) infection is a pandemic with regional outbreaks, including in industrialized countries. HEV infection is usually self-limiting but can progress to chronic hepatitis E in transplant recipients and HIV-infected patients. Whether other immunocompromised hosts, including rheumatology and internal medicine patients, are at risk of developing chronic HEV infection is unclear. <b>Methods:</b> We conducted a retrospective European multicenter cohort study involving 21 rheumatology and internal medicine patients with HEV infection between April 2014 and April 2016. The underlying diseases included rheumatoid arthritis (<i>n</i> = 5), psoriatic arthritis (<i>n</i> = 4), other variants of chronic arthritis (<i>n</i> = 4), primary immunodeficiency (<i>n</i> = 3), systemic granulomatosis (<i>n</i> = 2), lupus erythematosus (<i>n</i> = 1), Erdheim⁻Chester disease (<i>n</i> = 1), and retroperitoneal fibrosis (<i>n</i> = 1). <b>Results:</b> HEV infection lasting longer than 3 months was observed in seven (33%) patients, including two (40%) patients with rheumatoid arthritis, three (100%) patients with primary immunodeficiency, one (100%) patient with retroperitoneal fibrosis and one (100%) patient with systemic granulomatosis. Patients with HEV infection lasting longer than 3 months were treated with methotrexate without corticosteroids (<i>n</i> = 2), mycophenolate mofetil/prednisone (<i>n</i> = 1), and sirolimus/prednisone (<i>n</i> = 1). Overall, 8/21 (38%) and 11/21 (52%) patients cleared HEV with and without ribavirin treatment, respectively. One patient experienced an HEV relapse after initially successful ribavirin therapy. One patient (5%) was lost to follow-up, and no patients died from hepatic complications. <b>Conclusion:</b> Rheumatology and internal medicine patients, including patients treated with methotrexate without corticosteroids, are at risk of developing chronic HEV infection. Rheumatology and internal medicine patients with abnormal liver tests should be screened for HEV infection. |
topic |
hepatitis E chronic hepatitis E disease-modifying antirheumatic drugs (DMARDs) ribavirin |
url |
https://www.mdpi.com/1999-4915/11/2/186 |
work_keys_str_mv |
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doaj-4fcaf6564e064e84b2dcbcf9ed74277b2020-11-24T20:40:18ZengMDPI AGViruses1999-49152019-02-0111218610.3390/v11020186v11020186Chronic Hepatitis E in Rheumatology and Internal Medicine Patients: A Retrospective Multicenter European Cohort StudySven Pischke0Jean-Marie Peron1Moritz von Wulffen2Johann von Felden3Christoph Höner zu Siederdissen4Sophie Fournier5Marc Lütgehetmann6Christoph Iking-Konert7Dominik Bettinger8Gabriella Par9Robert Thimme10Alain Cantagrel11Ansgar W. Lohse12Heiner Wedemeyer13Robert de Man14Vincent Mallet15Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyService d’hépato-gastroentérologie, Hôpital Purpan CHU Toulouse, Université Paul Sabatier III, 31000 Toulouse, FranceDepartment of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyGastroenterology, Hannover Medical School, 30625 Hannover, GermanyService d’hépato-gastroentérologie, Hôpital Purpan CHU Toulouse, Université Paul Sabatier III, 31000 Toulouse, FranceGerman Centre for Infection Research (DZIF), Hamburg partner site, 20246 Hamburg, GermanyRheumatology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, GermanyClinical Centre, First Department of Medicine, University of Pécs, H-7622 Pécs, HungaryDepartment of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, GermanyService d’hépato-gastroentérologie, Hôpital Purpan CHU Toulouse, Université Paul Sabatier III, 31000 Toulouse, FranceDepartment of Medicine, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, GermanyGerman Centre for Infection Research (DZIF), Hamburg partner site, 20246 Hamburg, GermanyGastroenterology and Hepatology, Erasmus MC Medical Center Rotterdam, 3062 PA Rotterdam, The NetherlandsUniversité Paris Descartes, Assistance Publique—Hôpitaux de Paris (AP—HP), Hôpital Cochin, Hepatology Service, Institut National de la Santé et de la Recherche Médicale unité 1223, Institut Pasteur, 75006 Paris, France<b>Objectives:</b> Hepatitis E virus (HEV) infection is a pandemic with regional outbreaks, including in industrialized countries. HEV infection is usually self-limiting but can progress to chronic hepatitis E in transplant recipients and HIV-infected patients. Whether other immunocompromised hosts, including rheumatology and internal medicine patients, are at risk of developing chronic HEV infection is unclear. <b>Methods:</b> We conducted a retrospective European multicenter cohort study involving 21 rheumatology and internal medicine patients with HEV infection between April 2014 and April 2016. The underlying diseases included rheumatoid arthritis (<i>n</i> = 5), psoriatic arthritis (<i>n</i> = 4), other variants of chronic arthritis (<i>n</i> = 4), primary immunodeficiency (<i>n</i> = 3), systemic granulomatosis (<i>n</i> = 2), lupus erythematosus (<i>n</i> = 1), Erdheim⁻Chester disease (<i>n</i> = 1), and retroperitoneal fibrosis (<i>n</i> = 1). <b>Results:</b> HEV infection lasting longer than 3 months was observed in seven (33%) patients, including two (40%) patients with rheumatoid arthritis, three (100%) patients with primary immunodeficiency, one (100%) patient with retroperitoneal fibrosis and one (100%) patient with systemic granulomatosis. Patients with HEV infection lasting longer than 3 months were treated with methotrexate without corticosteroids (<i>n</i> = 2), mycophenolate mofetil/prednisone (<i>n</i> = 1), and sirolimus/prednisone (<i>n</i> = 1). Overall, 8/21 (38%) and 11/21 (52%) patients cleared HEV with and without ribavirin treatment, respectively. One patient experienced an HEV relapse after initially successful ribavirin therapy. One patient (5%) was lost to follow-up, and no patients died from hepatic complications. <b>Conclusion:</b> Rheumatology and internal medicine patients, including patients treated with methotrexate without corticosteroids, are at risk of developing chronic HEV infection. Rheumatology and internal medicine patients with abnormal liver tests should be screened for HEV infection.https://www.mdpi.com/1999-4915/11/2/186hepatitis Echronic hepatitis Edisease-modifying antirheumatic drugs (DMARDs)ribavirin |