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Peeters M, Schenk J, De Somer T, Roskams T, Locus T, Klamer S, Subissi L, Suin V, Delwaide J, Stärkel P, De Maeght S, Willems P, Colle I, Van Hoof M, Van Acker J, Van Steenkiste C, Moreno C, Janssens F, Reynders M, Steverlynck M, Verlinden W, Lasser L, de Galocsy C, Geerts A, Maus J, Gallant M, Van Outryve S, Marot A, Reynaert H, Decaestecker J, Bottieau E, Schreiber J, Mulkay JP, de Goeij S, Salame M, Dooremont D, Dastis SN, Boes J, Nijs J, Beyls J, Hens N, Nevens F, Van Gucht S, Vanwolleghem T. Viral clade is associated with severity of symptomatic genotype 3 hepatitis E virus infections in Belgium, 2010-2018. J Hepatol 2023; 78:67-77. [PMID: 36075495 DOI: 10.1016/j.jhep.2022.08.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND & AIMS HEV genotype (gt) 3 infections are prevalent in high-income countries and display a wide spectrum of clinical presentations. Host - but not viral - factors are reported to be associated with worse clinical outcomes. METHODS Demographic, clinical, and biochemical data laboratory-confirmed HEV infections (by PCR and/or a combination of IgM and IgG serology) at the Belgian National Reference Centre between January 2010 and June 2018 were collected using standardised case report forms. Genotyping was based on HEV open reading frame 2 sequences. Serum CXCL10 levels were measured by a magnetic bead-based assay. H&E staining was performed on liver biopsies. RESULTS A total of 274 HEV-infected individuals were included. Subtype assignment was possible for 179/218 viraemic cases, confirming gt3 as dominant with an almost equal representation of clades abchijklm and efg. An increased hospitalisation rate and higher peak serum levels of alanine aminotransferase, bilirubin, and alkaline phosphatase were found in clade efg-infected individuals in univariate analyses. In multivariable analyses, clade efg infections remained more strongly associated with severe disease presentation than any of the previously identified host risk factors, being associated with a 2.1-fold higher risk of hospitalisation (95% CI 1.1-4.4, p = 0.034) and a 68.2% higher peak of bilirubin levels (95% CI 13.3-149.9, p = 0.010), independently of other factors included in the model. In addition, acute clade efg infections were characterised by higher serum CXCL10 levels (p = 0.0005) and a more pronounced liver necro-inflammatory activity (p = 0.022). CONCLUSIONS In symptomatic HEV gt3 infections, clade efg is associated with a more severe disease presentation, higher serum CXCL10 levels, and liver necro-inflammatory activity, irrespective of known host risk factors. CLINICAL TRIAL REGISTRATION The protocol was submitted to clinicaltrials.gov (NCT04670419). IMPACT AND IMPLICATIONS HEV genotype (gt) 3 infections display a wide spectrum of clinical presentations currently ascribed to host factors. Here we examined the role of viral factors on liver disease outcomes by combining viral phylogeny with clinical, biochemical, cytokine, and histological data from 274 Belgian adults infected with HEV presenting between 2010 and 2018. HEV gt 3 clade efg infections were associated with a more severe disease presentation, higher serum CXCL10 levels and liver necro-inflammatory activity, irrespective of known host risk factors. HEV gt3 clade-dependent clinical outcomes call for broad HEV gt3 subtyping in clinical practice and research to help identify those at higher risk for worse outcomes and to further unravel underlying virus-host interactions.
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Affiliation(s)
- Michael Peeters
- Sciensano, Infectious Diseases in Humans, Viral Diseases, National Reference Centre of Hepatitis Viruses, Brussels, Belgium
| | - Julie Schenk
- University of Antwerp, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, Centre for Health Economic Research and Modelling Infectious Diseases, Antwerp, Belgium; Hasselt University, Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt, Belgium
| | - Thomas De Somer
- University Hospital Antwerp, Gastroenterology & Hepatology, Antwerp, Belgium; Maria Middelares Hospital, Gastroenterology & Hepatology, Ghent, Belgium
| | - Tania Roskams
- KU Leuven, Pathology, Translational Cell and Tissue Research, Leuven, Belgium
| | - Tatjana Locus
- Sciensano, Infectious Diseases in Humans, Viral Diseases, National Reference Centre of Hepatitis Viruses, Brussels, Belgium
| | - Sofieke Klamer
- Sciensano, Epidemiology of Infectious Diseases, Brussels, Belgium
| | - Lorenzo Subissi
- Sciensano, Infectious Diseases in Humans, Viral Diseases, National Reference Centre of Hepatitis Viruses, Brussels, Belgium; European Public Health Microbiology Training Program (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Vanessa Suin
- Sciensano, Infectious Diseases in Humans, Viral Diseases, National Reference Centre of Hepatitis Viruses, Brussels, Belgium
| | - Jean Delwaide
- University Hospital Liege, Gastroenterology & Hepatology, Liege, Belgium
| | - Peter Stärkel
- Cliniques Universitaires Saint-Luc (CUSL), Gastroenterology & Hepatology, Brussels, Belgium
| | | | | | - Isabelle Colle
- A.S.Z. Aalst, Gastroenterology & Hepatology, Aalst, Belgium; Ghent University Hospital, Department of Hepatology and Gastroenterology, Ghent, Belgium
| | - Marc Van Hoof
- Clinique Saint-Luc, Gastroenterology & Hepatology, Bouge, Belgium
| | - Jos Van Acker
- AZ Sint-Lucas, Clinical Microbiology, Ghent, Belgium
| | - Christophe Van Steenkiste
- University Hospital Antwerp, Gastroenterology & Hepatology, Antwerp, Belgium; Maria Middelares Hospital, Gastroenterology & Hepatology, Ghent, Belgium
| | - Christophe Moreno
- CUB Hôpital Erasme, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Université Libre de Bruxelles, Brussels, Belgium
| | - Filip Janssens
- Jessa Hospital, Gastroenterology & Hepatology, Hasselt, Belgium
| | - Marijke Reynders
- AZ Sint-Jan Brugge-Oostende AV, Medical Microbiology, Laboratory Medicine, Brugge, Belgium
| | | | - Wim Verlinden
- University Hospital Antwerp, Gastroenterology & Hepatology, Antwerp, Belgium; Vitaz, Gastroenterology & Hepatology, Sint-Niklaas, Belgium; University of Antwerp, Laboratory of Experimental Medicine and Pediatrics, Viral Hepatitis Research Group, Antwerp, Belgium
| | - Luc Lasser
- CHU Brugmann, Gastroenterology & Hepatology, Brussels, Belgium
| | | | - Anja Geerts
- Ghent University Hospital, Gastroenterology & Hepatology, Ghent, Belgium
| | - Jeroen Maus
- ZNA Middelheim, Gastroenterology & Hepatology, Antwerp, Belgium
| | - Marie Gallant
- Jan Yperman Ziekenhuis, Gastroenterology & Hepatology, Ieper, Belgium
| | | | - Astrid Marot
- CHU UCL Namur, Université Catholique de Louvain, Department of Gastroenterology and Hepatology, Yvoir, Belgium
| | - Hendrik Reynaert
- University Hospital UZ Brussel, Gastroenterology & Hepatology, Brussels, Belgium
| | | | | | - Jonas Schreiber
- CHIREC Delta Hospital, Gastroenterology & Hepatology, Brussels, Belgium
| | | | | | - Mikhaël Salame
- Centre Hospitalier Régional Haute Senne, Soignies, Belgium
| | | | | | | | - Jochen Nijs
- Sint-Trudo Ziekenhuis, Department of Gastroenterology, Sint-Truiden, Belgium
| | - Jan Beyls
- Sint-Andriesziekenhuis, Department of Gastroenterology, Tielt, Belgium
| | - Niel Hens
- University of Antwerp, Faculty of Medicine and Health Sciences, Vaccine & Infectious Disease Institute, Centre for Health Economic Research and Modelling Infectious Diseases, Antwerp, Belgium; Hasselt University, Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt, Belgium
| | - Frederik Nevens
- University Hospitals KU Leuven, Gastroenterology & Hepatology, Leuven, Belgium
| | - Steven Van Gucht
- Sciensano, Infectious Diseases in Humans, Viral Diseases, National Reference Centre of Hepatitis Viruses, Brussels, Belgium.
| | - Thomas Vanwolleghem
- University Hospital Antwerp, Gastroenterology & Hepatology, Antwerp, Belgium; University of Antwerp, Laboratory of Experimental Medicine and Pediatrics, Viral Hepatitis Research Group, Antwerp, Belgium.
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