title: Hepatitis E Virus (HEV) ORF2 Antigen Levels Differentiate Between Acute and Chronic HEV Infection.
abstract: BACKGROUND
  Hepatitis E virus (HEV) genotype 3 infections are frequent in Europe and North America, with acute and chronic courses described in the literature. HEV RNA detection by real-time polymerase chain reaction (PCR) is the gold standard for diagnosis. Recently, an anti-HEV antigen (Ag)-specific enzyme-linked immunosorbent assay (ELISA) directed against the HEV capsid became commercially available. The effectiveness of anti-HEV Ag-specific ELISA at detecting HEV genotype 3 infections remains undefined.
  
  
  METHODS
  The performance of anti-HEV Ag-ELISA was compared with that of real-time PCR, using sera from a cohort of acutely infected individuals, in addition to a cohort of chronically infected patients undergoing ribavirin therapy. Furthermore, virion properties were evaluated by density fractionation.
  
  
  RESULTS
  Anti-HEV Ag-specific ELISA was less sensitive than real-time PCR at detection of HEV infection. Anti-HEV Ag-specific ELISA revealed significantly higher HEV Ag in chronically infected individuals as compared to acutely infected patients, with high sensitivity and specificity to distinguish acute from chronic HEV infection. Of note, HEV Ag remained detectable for >100 days after HEV RNA clearance in ribavirin-treated patients with chronic HEV. Density gradients revealed the presence of membrane-associated virions in the sera, with a different distribution as compared to HEV RNA.
  
  
  CONCLUSIONS
  The anti-HEV Ag-specific ELISA is less sensitive than HEV RNA real-time PCR but represents a useful tool to discriminate chronic from acute infection.
authors.affiliation: TWINCORE, Center for Experimental and Clinical Infection Research, Institute for Experimental Infection Research German Center for Infection Research Department for Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover.
authors.forename: Patrick
authors.initials: P
authors.lastname: Behrendt
authors.affiliation: Department for Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover.
authors.forename: Birgit
authors.initials: B
authors.lastname: Bremer
authors.affiliation: TWINCORE, Center for Experimental and Clinical Infection Research, Institute for Experimental Infection Research.
authors.forename: Daniel
authors.initials: D
authors.lastname: Todt
authors.affiliation: TWINCORE, Center for Experimental and Clinical Infection Research, Institute for Experimental Infection Research.
authors.forename: Richard J P
authors.initials: RJ
authors.lastname: Brown
authors.affiliation: Institute of Virology Hannover Medical School, Germany.
authors.forename: Albert
authors.initials: A
authors.lastname: Heim
authors.affiliation: German Center for Infection Research Department for Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.affiliation: TWINCORE, Center for Experimental and Clinical Infection Research, Institute for Experimental Infection Research.
authors.forename: Eike
authors.initials: E
authors.lastname: Steinmann
authors.affiliation: German Center for Infection Research Department for Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover.
authors.forename: Heiner
authors.initials: H
authors.lastname: Wedemeyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D016751:Hepatitis E / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014764:Viral Proteins / Q000097:blood*; D055815:Young Adult
chemical_list: C400971:ORF2 protein, Hepatitis E virus; D014764:Viral Proteins
keywords: acute infection; antigen level; chronic infection; hepatitis E virus; virion properties