title: Hepatitis E in patients with hepatic disorders and HIV-infected patients in Croatia: is one diagnostic method enough for hepatitis E diagnosis?
abstract: We assessed hepatitis E virus (HEV) seroprevalence in patients with hepatic disorders as well as in human immunodeficiency virus (HIV)-infected patients and emphasised the issue of possible non-specific anti-HEV seroresponse and need for combining diagnostic methods for hepatitis E diagnosis. Over a two-year period, from March 2011 to February 2013, we determined anti-HEV immunoglobulin M (IgM) and IgG by enzyme immunoassays (EIA; Mikrogen, Germany) in 504 hepatitis patients negative for acute viral hepatitis A-C. Furthermore, 88 samples from randomly selected consecutive HIV-infected patients were also analysed. All EIA reactive samples were additionally tested by line immunoblot assays (LIA; Mikrogen, Germany). HEV nested reverse transcription polymerase chain reaction (RT-PCR) was carried out in 14 anti-HEV IgM LIA-positive patients. Anti-HEV IgM or IgG were detected in 16.9 % of patients by EIA and confirmed by LIA in 10.7 % [95 % confidence interval (CI) 8.3-13.7 %] of hepatitis patients. HEV RNA was detected in five patients. The agreement between EIA and LIA assessed by Cohen's kappa was 0.47 (95 % CI 0.55-0.75) for IgM and 0.83 (95 % CI 0.78-0.93) for IgG. Anti-HEV IgM and IgG seroprevalence in HIV-infected patients was 1.1 %, respectively. Our findings show a rather high HEV seroprevalence in patients with elevated liver enzymes in comparison to HIV-infected patients. Discordant findings by different methods stress the need to combine complementary methods and use a two-tier approach with prudent interpretation of reactive serological results for hepatitis E diagnosis.
authors.affiliation: University Hospital for Infectious Diseases, Mirogojska 8, 10000, Zagreb, Croatia, orode@bfm.hr.
authors.forename: O
authors.initials: O
authors.lastname: Ðaković Rode
authors.forename: L
authors.initials: L
authors.lastname: Jemeršić
authors.forename: D
authors.initials: D
authors.lastname: Brnić
authors.forename: N
authors.initials: N
authors.lastname: Pandak
authors.forename: R
authors.initials: R
authors.lastname: Mikulić
authors.forename: J
authors.initials: J
authors.lastname: Begovac
authors.forename: A
authors.initials: A
authors.lastname: Vince
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017523:Croatia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D006508:Hepatitis Antibodies