Hepatitis E Virus Infection in Cancer Patients

Area of Science:

• Hepatology
• Infectious Diseases
• Oncology

Background:

• Hepatitis E virus (HEV) infection can cause chronic hepatitis and liver failure in immunocompetent individuals.
• The prevalence and characteristics of HEV infection in cancer patients remain largely uncharacterized.
• Cancer patients may have unique risks due to their underlying condition and treatments.

Purpose of the Study:

• To investigate the prevalence and clinical features of Hepatitis E virus infection in adult cancer patients.
• To identify risk factors and outcomes associated with HEV infection in this vulnerable population.
• To report the first cases of chronic HEV infection in patients undergoing CAR T-cell therapy.

Main Methods:

• Retrospective analysis of adult cancer patients diagnosed with HEV infection between September 2011 and September 2021 at a US tertiary care cancer center.
• Review of patient demographics, medical history, HEV testing results (IgG and RNA), and treatment outcomes.
• Detailed case review of two patients with detectable HEV RNA, including their malignancy type, treatment history, and clinical course.

Main Results:

• Of 405 tested patients, 63 (16%) had detectable HEV IgG.
• Only two patients (3.2%) had detectable HEV RNA, indicating active infection.
• One patient with myelodysplastic syndrome post-allogeneic stem cell transplantation experienced resolved viremia after immunosuppression reduction.
• Another patient with diffuse large B-cell lymphoma post-CAR T-cell therapy developed chronic HEV infection refractory to ribavirin.

Conclusions:

• HEV infection appears to be as common in cancer patients as in the general population.
• Cancer patients, particularly those with hematologic malignancies, are at risk for HEV viremia.
• The development of chronic HEV infection, potentially refractory to standard treatment, is a concern in immunocompromised cancer patients, including those treated with CAR T-cell therapy.