Review Article

Hepatitis E—A Concise Review of Virology, Epidemiology, Clinical Presentation and Therapy

M. C. Donnelly; L. Scobie; C. L. Crossan; H. Dalton; P. C. Hayes; K. J. Simpson


Aliment Pharmacol Ther. 2017;46(2):126-141. 

In This Article

HEV Reinfection

Re-infection with HEV is reported, and can be identified by a rapid increase in anti-HEV IgG levels, with HEV RNA becoming detectable. Abravanel followed a cohort of 263 solid organ transplant recipients for 1 year; in addition to three cases of de novo HEV infection, there were three cases of HEV reinfection.[123] Patients who tested positive for anti-HEV IgG, with or without detection of anti-HEV IgM at transplantation, and tested positive for HEV RNA during follow-up were considered to have become reinfected. Reinfection with HEV can lead to a chronic infection and further studies are required to evaluate the clinical importance of HEV reinfection in immunosuppressed patients.

Previously, reinfection or chronic infection was associated only with immunosuppressed patients and not the healthy donor population. However, Baylis recently reported HEV re-infection in a small percentage of plasma donors, as suggested by anti-HEV IgG with high avidity and high viral loads, in the absence of anti-HEV IgM.[124] Schemmerer also reported reinfection in 8.8% of individual patient courses;[125] the pre-existing anti-HEV IgG concentration was <7 WU/mL, and one patient had a serologic profile indicating four consecutive reinfections in intervals of 1.2–3.4 years.