Abstract Background Hepatitis E virus (HEV) is an RNA virus with 8 genotypes. Genotypes 3 and 4 are predominate in Europe and are transmitted zoonotically, mainly via undercooked pork or venison. While HEV infection is usually acute and asymptomatic, chronic infection may develop in immunocompromised individuals, especially after solid organ transplantation1. Data on HEV in patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapy remain limited. Methods We report the course of HEV infection in six consecutive IBD patients on advanced therapy (biologics or small molecules) diagnosed between 2024-2025. Before the diagnosis of HEV infection, patients underwent differential diagnosis of elevated transaminases consisting of a detailed medical history, extensive laboratory tests (including HAV, HBV, HCV, EBV, CMV serology) and abdominal ultrasound with liver elastography (SWE) – all with negative results. We established the diagnosis of HEV infection based on positive serology and HEV viremia using quantitative polymerase chain reaction (PCR). The cohort included two patients with Crohn’s disease and four with ulcerative colitis (three males, age 27–58 years). Two patients were on anti-TNFs, one on ustekinumab, and three on JAK inhibitors (one combined with vedolizumab), two were taking cortikosteroids (Supplementary Table 1). One patient was six weeks pregnant. Results All infections were asymptomatic or mild (fatigue, malaise) with newly elevated transaminases detected during routine visits. Median ALT was 14.015 µkat/l and AST 6.55 µkat/l. Initial viremia ranged from 38 170 to 908 700 IU/ml. All patients discontinued advanced therapy after the diagnosis of HEV infection and were monitored on an outpatient basis, except for a pregnant patient, who was hospitalized during the first week at the department of Infectious Diseases. No hepatic dysfunction occurred. Transaminases normalized within four weeks (Figure 1). Two patients cleared viremia at week 4, all by week 12. None developed chronic infection. After HEV clearance, all resumed prior therapy without complications. Follow-up elastography showed no fibrosis and all achieved seroconversion despite ongoing immunosuppression. The pregnant patient delivered a healthy infant at term. Conclusion Hepatitis E infection had an acute and benign course in all patients with IBD who were treated with different types of biologic or small molecule therapy. No patient developed chronic infection. HEV infection during pregnancy did not cause a worse outcome. We did not observe systemic corticosteroids to be a risk factor for the development of chronic HEV. Despite ongoing immunosuppression, seroconversion occurred after infection in all cases. Reference: 1. Ma Z, et al. J Hepatol. 2022; 77(4): 1109-1123 Conflict of interest: Mr. Jirsa, Jakub: No conflict of interest Kubickova, Kristyna: No conflict of interest Duricova, Dana: Personal Fees: Lecture fee from Janssen, Takeda, Pfizer, Eli Lilly, AbbVie, Ferring.
Jirsa et al. (Thu,) studied this question.