Hepatitis E Virus Infection in Hemodialysis Patients: A Seroepidemiological Survey in Jahrom, Southern Iran

Background and Aims: Hepatitis E virus (HEV) is mainly the causative agent of waterborne epidemics, but some authors have found that patients on chronic hemodialysis have an increased risk of exposure to HEV. We conducted this study to reveal HEV seroprevalence in hemodialysis patients as a specific group in Iran, and to evaluate age, duration of hemodialysis, and the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in them.

Methods: The presence of immunoglobulin G antibodies to HEV(anti-HEV IgG) was measured by enzyme-linked immunosorbent assay (ELISA) in the patients' sera. Both ALT and AST serum levels were measured. The duration of hemodialysis and the age and sex of the participants were obtained from the medical records of patients, and the data were made into quantitative variables, which were expressed as mean ± standard deviation (SD).

Results: 43 patients (29 males and 14 females) enrolled in this study. 3 of these patients (7% of the sample) were HEV antibody positive (2 males and 1 female). The mean levels of AST and ALT in all of the studied patients were 22.3 ± 23.3 IU/L and 21.3 ± 27.6 IU/L, respectively. An association between HEV positivity and duration of hemodialysis was revealed by our results, but there was no significant association between HEV antibody positivity and patient age. All 3 patients who were positive for anti-HEV antibody in our study also had elevated liver enzymes.

Conclusions: The finding that HEV infection was associated with elevated liver enzymes in patients who were on chronic hemodialysis may indicate that hemodialysis is a route for HEV transmission, and more controlled studies are needed to explore this association in Iran.