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Abstract(s)
Objetivo: O vírus da Hepatite E (HEV) causa hepatite em indivíduos saudáveis, no entanto, em países desenvolvidos, a infeção por HEV pode evoluir para crónica em pacientes imunocomprometidos. Pouco se sabe sobre a infeção por HEV em recetores de transplante de células-tronco hematopoiéticas (HSCT), e o seu estado prolongado de imunossupressão torna-os um grupo de risco importante. Resumimos todas publicações sobre infeções por HEV em recetores de HSCT e desenvolvemos um estudo retrospetivo
epidemiológico para caracterizar a prevalência de HEV num coorte de HSCT alogénicos. Métodos: O estudo I foi realizado para resumir todos os dados publicados sobre infeções por HEV em recetores de HSCT, realizando uma revisão sistemática da literatura. A pesquisa bibliográfica foi conduzida na PubMed e Scopus e as guidelines PRISMA foram seguidas. O software MetaXL foi utilizado na análise estatística para estimar a
prevalência geral de infeção por HEV de acordo com as diferentes abordagens de diagnóstico (deteção de RNA HEV e anti-HEV IgM/IgG). O estudo II foi desenvolvido como um estudo retrospetivo num coorte de 196 pacientes submetidos a alo-HSCT entre 2016-2018, no qual rastreamos o RNA HEV por RT-PCR em tempo real e para anti-HEV IgM e IgG usando um imunoensaio enzimático. Resultados: No estudo I, foram encontrados 7 manuscritos que relatam uma prevalência geral de anti-HEV IgM/IgG de 12,0% (IC95%: 0,16-28,5) e prevalência de RNA HEV de 1,50% (IC95%: 0,70-2,60). A prevalência isolada de anti-HEV IgM foi de 2,00% (IC95%: 0,30-4,50) e a anti-HEV IgG foi de 11,4% (IC95%: 1,80-26,3). O estudo II revelou uma prevalência de anti-HEV IgG de 19,9%. Além disso, encontramos uma prevalência de infeção recente/ativa por HEV de 4,1%, com 6 casos positivos para RNA HEV e 2 casos positivos para anti-HEV IgM e IgG.
Conclusão: Nos últimos anos, alguma atenção foi dada a este grupo de imunocomprometidos, mas ainda há um número reduzido de estudos. Este estudo mostra que os recetores de alo-HSCT estão em risco de infeção por HEV, portanto devem ser rastreados antes do transplante e durante episódios de elevação das enzimas hepáticas após transplante com o teste de RNA HEV. No entanto, são necessários mais estudos para aumentar a nossa compreensão da epidemiologia do HEV em receptores de HSCT, visto que pode ser um fator importante no resultado dos pacientes.
Aim: Hepatitis E virus (HEV) causes hepatitis in healthy individuals, however, in developed countries, HEV infection can evolve to chronic hepatitis in immunosuppressed patients. Little is known of HEV infection in hematopoietic stem cell transplant (HSCT) recipients, and their prolonged immunosuppression state makes them an important risk group. We summarize all published data regarding HEV infections in HSCT recipients and developed an epidemiology study to characterize HEV prevalence in a retrospective cohort of allo-HSCT. Methods: Study I was performed to summarize all published data regarding HEV infections in HSCT recipients by performing a systematic review of the literature. Literature search was conducted in PubMed and Scopus and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The MetaXL software was used for statistical analysis to estimate the overall prevalence of HEV infection according to the different diagnostic approaches (HEV RNA and anti-HEV IgM/IgG detection). Study II was developed as a retrospective study in a cohort of 196 patients submitted to allo-HSCT between 2016-2018, on which we screened for HEV RNA by real-time RT-PCR and for anti-HEV IgM and IgG using an enzyme immunoassay. Results: In study I, we found 7 manuscripts reporting an overall anti-HEV IgM/IgG prevalence of 12.0% (95% CI: 0.16-28.5) and HEV RNA prevalence of 1.50% (95% CI: 0.70-2.60). Isolated anti-HEV IgM prevalence was 2.00% (95% CI: 0.30-4.50), and antiHEV IgG was 11.4% (95% CI: 1.80-26.3). Study II revealed an anti-HEV IgG prevalence of 19,9%. Furthermore, we found a prevalence of recent/active HEV infection of 4.1%, with 6 positive cases for HEV RNA, and 2 positive cases for both HEV IgM and IgG. Conclusion: Over the last years, some attention has been given to this group of immunocompromised patients, but there is still a small number of studies. This study shows that recipients of allo-HSCT are at risk for HEV infection. Therefore, allo-HSCT recipients should be screened prior transplantation, and during episodes of liver enzyme abnormalities post-transplantation, with HEV RNA testing as the preferred diagnostic method in these immunocompromised patients. Nevertheless, more studies are needed to increase our understanding of the epidemiology of HEV in HSCT recipients, as it may be an important factor in the outcome of patients.
Aim: Hepatitis E virus (HEV) causes hepatitis in healthy individuals, however, in developed countries, HEV infection can evolve to chronic hepatitis in immunosuppressed patients. Little is known of HEV infection in hematopoietic stem cell transplant (HSCT) recipients, and their prolonged immunosuppression state makes them an important risk group. We summarize all published data regarding HEV infections in HSCT recipients and developed an epidemiology study to characterize HEV prevalence in a retrospective cohort of allo-HSCT. Methods: Study I was performed to summarize all published data regarding HEV infections in HSCT recipients by performing a systematic review of the literature. Literature search was conducted in PubMed and Scopus and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The MetaXL software was used for statistical analysis to estimate the overall prevalence of HEV infection according to the different diagnostic approaches (HEV RNA and anti-HEV IgM/IgG detection). Study II was developed as a retrospective study in a cohort of 196 patients submitted to allo-HSCT between 2016-2018, on which we screened for HEV RNA by real-time RT-PCR and for anti-HEV IgM and IgG using an enzyme immunoassay. Results: In study I, we found 7 manuscripts reporting an overall anti-HEV IgM/IgG prevalence of 12.0% (95% CI: 0.16-28.5) and HEV RNA prevalence of 1.50% (95% CI: 0.70-2.60). Isolated anti-HEV IgM prevalence was 2.00% (95% CI: 0.30-4.50), and antiHEV IgG was 11.4% (95% CI: 1.80-26.3). Study II revealed an anti-HEV IgG prevalence of 19,9%. Furthermore, we found a prevalence of recent/active HEV infection of 4.1%, with 6 positive cases for HEV RNA, and 2 positive cases for both HEV IgM and IgG. Conclusion: Over the last years, some attention has been given to this group of immunocompromised patients, but there is still a small number of studies. This study shows that recipients of allo-HSCT are at risk for HEV infection. Therefore, allo-HSCT recipients should be screened prior transplantation, and during episodes of liver enzyme abnormalities post-transplantation, with HEV RNA testing as the preferred diagnostic method in these immunocompromised patients. Nevertheless, more studies are needed to increase our understanding of the epidemiology of HEV in HSCT recipients, as it may be an important factor in the outcome of patients.
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Keywords
Vírus da hepatite E Transplante de células-tronco hematopoiéticas Prevalência Hepatitis E virus Hematopoietic stem cell transplantation Prevalence