Emerging Microbes & Infections
ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/temi20
Seroprevalence of AIH-related autoantibodies in
patients with acute hepatitis E viral infection: a
prospective case–control study in China
Jian Wu, Naizhou Guo, Lifei Zhu, Xueyan Zhang, Cunquan Xiong, Jun Liu,
Yanping Xu, Jun Fan, Jiong Yu, Qiaoling Pan, Jinfeng Yang, Hanying Liang,
Xiuyuan Jin, Sunyi Ye, Wei Wang, Chengyuan Liu, Jinrong Zhang, Gongqi Li,
Bin Jiang, Hongcui Cao & Lanjuan Li
To cite this article: Jian Wu, Naizhou Guo, Lifei Zhu, Xueyan Zhang, Cunquan Xiong, Jun Liu,
Yanping Xu, Jun Fan, Jiong Yu, Qiaoling Pan, Jinfeng Yang, Hanying Liang, Xiuyuan Jin, Sunyi Ye,
Wei Wang, Chengyuan Liu, Jinrong Zhang, Gongqi Li, Bin Jiang, Hongcui Cao & Lanjuan Li (2020)
Seroprevalence of AIH-related autoantibodies in patients with acute hepatitis E viral infection:
a prospective case–control study in China, Emerging Microbes & Infections, 9:1, 332-340, DOI:
10.1080/22221751.2020.1722759
To link to this article: https://doi.org/10.1080/22221751.2020.1722759
© 2020 The Author(s). Published by Informa Published online: 10 Feb 2020.
UK Limited, trading as Taylor & Francis
Group, on behalf of Shanghai Shangyixun
Cultural Communication Co., Ltd
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, Emerging Microbes & Infections
2020, VOL. 9
https://doi.org/10.1080/22221751.2020.1722759
Seroprevalence of AIH-related autoantibodies in patients with acute hepatitis E
viral infection: a prospective case–control study in China
Jian Wua,b*, Naizhou Guob*, Lifei Zhua, Xueyan Zhangc, Cunquan Xiongc, Jun Liud, Yanping Xua, Jun Fana,
Jiong Yua, Qiaoling Pana, Jinfeng Yanga, Hanying Lianga, Xiuyuan Jina, Sunyi Yea, Wei Wangb,
Chengyuan Liub, Jinrong Zhange, Gongqi Lif, Bin Jiangg, Hongcui Cao a,h and Lanjuan Lia
a
State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The
First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; bDepartment of Laboratory
Medicine, The First People’s Hospital of Yancheng City, Yancheng, People’s Republic of China; cDepartment of Public Health, Jiangsu
Vocational College of Medicine, Yancheng, People’s Republic of China; dDepartment of Laboratory Medicine, The Fifth People’s Hospital of
Wuxi, Affiliated to Jiangnan University, Wuxi, People’s Republic of China; eDepartment of Laboratory Medicine, The People’s Hospital of
Dafeng City, Yancheng, People’s Republic of China; fDepartment of Clinical Laboratory, Linyi Traditional Hospital, Linyi, People’s Republic of
China; gDepartment of Laboratory Medicine, The Central Blood Station of Yancheng City, Yancheng, People’s Republic of China; hZhejiang
Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, Hangzhou, People’s Republic of China
ABSTRACT
The seroprevalenc of autoimmune hepatitis (AIH)-related antibodies in patients, particularly Asians, with acute hepatitis E
(AHE) is unclear. In this study, we investigated whether acute hepatitis E virus (HEV) infection is associated with the
seroprevalence of AIH-related autoantibodies and assessed their impact on the disease characteristics. AIH-related
autoantibodies were detected by indirect immunofluorescence in 198 AHE patients and 50 type 1 AIH patients. The
positivity rates of against nuclear antigen (ANA) and smooth muscles antibody (SMA) in AHE patients were 37.4% and
22.7%, and the total positivity rate was 50%. Compared to those in AIH patients, the positivity rates of ANA-H and
SMA-AA were significantly lower (35.1% vs. 82.1% and 4.4% vs. 88.4%). Female gender and the ALT level, but not
immunosuppressive or antiviral drugs, were independently predictive of the presence of AIH-related autoantibodies in
AHE patients. Fifty-two patients positive for AIH-related autoantibodies were followed up for 12 months. During this
period, 33 of them became negative and 19 remained positive, albeit with significantly decreased titres. In
conclusions, the seroprevalence of AIH-related autoantibodies in AHE patients was elevated, particularly in females,
but their subspecificities and titres differed from those of type 1 AIH. Acute HEV infection may be related to AIH.
Abbreviations: AIH: autoimmune hepatitis; AHE: acute hepatitis E; ANA: against nuclear antigen; SMA: smooth muscles
antibody; ANA-H: ANA with homogeneous pattern; SMA-AA: SMA with anti-actin pattern; Anti-LKM1: anti- liver-kidney
microsomes-1 antibody; ANCA: anti-neutrophil cytoplasmic antibody; AMA: anti-mitochondrial antibody; Anti-SLA: anti-
soluble liver antigen; Anti-LC1: anti-liver cytoplasmic type 1 antibody; pANCA: perinuclear antineutrophil cytoplasmic
antibody
ARTICLE HISTORY Received 15 November 2019; Revised 20 January 2020; Accepted 22 January 2020
KEYWORDS anti-nuclear antibody (ANA); anti-smooth muscle antibody (SMA); autoimmune hepatitis (AIH); acute hepatitis E (AHE); seroprevalence
Introduction
export of labour services has increased the prevalence
Acute hepatitis E (AHE) is a viral hepatitis caused by of AHE in developed countries [4, 5]. Approximately
hepatitis E virus (HEV) infection. HEV is transmitted one-third of the global population (∼2 billion) lives
mainly through faecal–oral routes and frequently in HEV-epidemic areas, rendering AHE an important
causes major outbreaks or epidemics [1, 2]. Compared public-health issue globally [6]. The HEV has four
with other types of hepatitis, the mortality rate of AHE major genotypes. Genotypes 1 and 2 are human
is high. AHE can cause severe jaundice and liver failure, viruses, an epidemiological pattern in most developing
leading to death. In the general population, the mor- countries of the world, which are transmitted via faecal
tality rate of AHE is 1–4%, whereas in older people oral routes through contaminated water and then
or pregnant women it can reach 20% [3]. AHE is infect humans, causing many water-borne disease out-
concentrated in developing countries. However, the breaks [7]. The second group includes genotypes 3 and
increasing global integration, development of transpor- 4, which are zoonotic viruses that are common in pigs
tation and tourism, frequent exchanges of people, and and humans, and have been associated with sporadic
CONTACT Hongcui Cao hccao@zju.edu.cn State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research
Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd., Hangzhou 310003, China
*These authors contributed equally to this work.
© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group, on behalf of Shanghai Shangyixun Cultural Communication Co., Ltd
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted
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