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HEV led to various hepatic manifestations, neurological syndromes

Many patients diagnosed with autochthonous hepatitis E virus infection in England eventually developed various hepatic manifestations because of the infection, according to study data.

“To date, there has been no systematic study of the frequency, severity and range of extra-hepatic manifestations of hepatitis E (virus infection),” the researchers wrote. “This study documents these extra-hepatic manifestations of hepatitis E infection in a defined cohort of patients from southwest England.”

In this retrospective review, researchers analyzed data collected from 106 patients from various hospitals throughout southwest England diagnosed with HEV between 1999 and 2013. The median age of all the patients was 63.5 years and most were male (n=81). One patient had chronic HEV, whereas the other 105 had acute HEV.

Eight patients developed neurological syndromes, including brachial neuritis, Guillain-Barre syndrome, peripheral neuropathy, neuromyopathy, small fiber neuropathy and vestibular neuritis. The patients showing neurological symptoms were younger compared with patients without neurological symptoms (median age, 40 vs. 64 years; P=.048), as well as had lower alanine aminotransferase levels (median ALT, 471 IU/L vs. 1,135 IU/L; P=.015). Among these patients, 62.5% showed neurological symptoms 5 years after diagnosis of infection.

Overall, 65 patients were diagnosed with monoclonal gammopathy of uncertain significance (MGUS), which led researchers to question whether it could have played a causative role in the premalignant condition among the specific HEV cohort, according to the research.    

“We have shown that hepatitis E is associated with a number of extra-hepatic manifestations,” the researchers concluded. “However, the observation that hepatitis E is associated with a number of extra-hepatic manifestations, including MGUS, does not necessarily imply causation. Larger, prospective studies are required to determine the aetiological role of HEV in these conditions and its contribution to diseases other than hepatitis.”

Disclosure: One researcher reports receiving consulting fees from Aptalis, Gilead, GlaxoSmithKline and Wantai; travel and accommodation costs from GFfe Blut GmBh, Gilead, GlaxoSmithKline, Merck and Wantai; and lecture fees from GFfe Blut GmBh and Merck.