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Diagnosis of hepatitis E

Nature Reviews Gastroenterology & Hepatology volume 10, pages 24–33 (2013)Cite this article

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Abstract

Hepatitis E, caused by infection with hepatitis E virus (HEV), is a common cause of enterically-transmitted acute hepatitis in developing countries. Occasional cases of sporadic hepatitis E have been increasingly recognized in developed countries over the past decade. These cases differ from those in developing countries in being possibly caused by zoonotic transmission, often affecting people with a suppressed immune system and occasionally leading to persistent HEV infection. The commonly used tests for HEV infection include detection of IgM and IgG anti-HEV antibodies and detection of HEV RNA. IgM anti-HEV antibodies can be detected during the first few months after HEV infection, whereas IgG anti-HEV antibodies represent either recent or remote exposure. The presence of HEV RNA indicates current infection, whether acute or chronic. Although several diagnostic assays for anti-HEV antibodies are available, they have undergone fairly limited testing and often provide discordant results, particularly for IgG antibodies. Thus, although the available antibody assays might be useful for case diagnosis in areas with high disease endemicity, their use for case diagnosis in areas with low endemicity and for seroprevalence studies remains problematic. Improved validation of existing anti-HEV antibody assays or development of new assays with superior performance characteristics is urgently needed.

Key Points

  • Hepatitis E, caused by infection with hepatitis E virus (HEV) is an important form of acute hepatitis in developing countries; in addition, sporadic cases of this disease are being increasingly recognized in developed countries

  • Clinical, biochemical and radiological findings are not useful in differential diagnosis of hepatitis E from other causes of liver injury

  • IgM and IgG antibodies to HEV are markers of recent (approximately within the previous 6 months) infection with HEV and prior exposure to this virus, respectively

  • Current anti-HEV antibody assays have suboptimal performance and results are often discordant, which generates diagnostic dilemmas, particularly in settings where the disease is infrequent or when the clinical presentation is atypical

  • In areas of low endemicity, it is useful to confirm the results of the IgM anti-HEV antibody assay using HEV RNA testing

  • Until improved anti-HEV antibody assays are developed, much caution is needed in the interpretation of results from current assays, particularly when results from different assays are compared

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Figure 1: Various laboratory tests used for diagnosis of HEV infection.
Figure 2: The format of various EIA systems used to detect anti-HEV antibodies.

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  1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India

    Rakesh Aggarwal

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Aggarwal, R. Diagnosis of hepatitis E. Nat Rev Gastroenterol Hepatol 10, 24–33 (2013). https://doi.org/10.1038/nrgastro.2012.187

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