Acute Hepatitis E Infection Accounts for Some Cases of Suspected Drug-Induced Liver Injury

Department of Transplantation, California Pacific Medical Center, San Francisco, California, USA.
Gastroenterology (Impact Factor: 16.72). 08/2011; 141(5):1665-72.e1-9. DOI: 10.1053/j.gastro.2011.07.051
Source: PubMed


The diagnosis of drug-induced liver injury relies on exclusion of other causes, including viral hepatitis A, B, and C. Hepatitis E virus (HEV) infection has been proposed as another cause of suspected drug-induced liver disease. We assessed the frequency of HEV infection among patients with drug-induced liver injury in the United States.
The Drug-Induced Liver Injury Network (DILIN) is a prospective study of patients with suspected drug-induced liver injury; clinical information and biological samples are collected to investigate pathogenesis and disease progression. We analyzed serum samples, collected from patients enrolled in DILIN, for immunoglobulin (Ig) G and IgM against HEV; selected samples were tested for HEV RNA.
Among 318 patients with suspected drug-induced liver injury, 50 (16%) tested positive for anti-HEV IgG and 9 (3%) for anti-HEV IgM. The samples that contained anti-HEV IgM (collected 2 to 24 weeks after onset of symptoms) included 4 that tested positive for HEV RNA genotype 3. Samples from the 6-month follow-up visit were available from 4 patients; they were negative for anti-HEV IgM, but levels of anti-HEV IgG increased with time. Patients who had anti-HEV IgM were mostly older men (89%; mean age, 67 years), and 2 were human immunodeficiency virus positive. Clinical reassessment of the 9 patients with anti-HEV IgM indicated that acute hepatitis E was the most likely diagnosis for 7 and might be the primary diagnosis for 2.
HEV infection contributes to a small but important proportion of cases of acute liver injury that are suspected to be drug induced. Serologic testing for HEV infection should be performed, particularly if clinical features are compatible with acute viral hepatitis.

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    • "This hepatitis is caused principally by hepatitis E virus (HEV) belonging to genotypes 1 and 2. In contrast, until recently, hepatitis E was rarely diagnosed in industrialized countries. However, a growing number of cases are being diagnosed, principally from European countries, but also from Great Britain, the USA and Japan.4,5,6 Most of these cases are thought to be food-borne and caused by HEV genotypes 3 and 4.7,8 Since genotypes 3 and 4 infect principally swine as well as humans (but also certain other species of domestic and wild animals, including boar, wild deer, cattle and sheep), autochthonous hepatitis caused by these genotypes in industrialized countries is thought to be zoonotic in nature and transmitted to humans principally via ingestion of undercooked pork. "
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