IgG antibody response demonstrates inverse correlation with viral load in Bangladeshi women with acute hepatitis E virus genotype 1 infection

• Published in: International journal of infectious diseases 2021-03, Vol.104, p.482-490
• Main Authors: Sultana, Rosy, Islam, Md Tarikul, Bhuyan, Golam Sarower, Sarker, Suprovath Kumar, Noor, Farjana Akther, Hossain, Mohabbat, Rashid, Mamunur, Rahmat, Redwan, Zaman, K., Begum, Mst. Noorjahan, Hassan, Zahid, Karim, Muhammad Manjurul, Qadri, Firdausi, Mannoor, Kaiissar
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Antibody index; Avidity index; Enzyme-Linked Immunosorbent Assay; Female; Genotype; Hepatitis Antibodies - blood; Hepatitis E - immunology; Hepatitis E - virology; Hepatitis E virus; Hepatitis E virus - genetics; Hepatitis E virus - immunology; Humans; IgG; Immunoglobulin G - blood; Immunoglobulin M - blood; Jaundice - virology; Log viral copy; Middle Aged; Pregnancy; Pregnancy Complications, Infectious - virology; Real-Time Polymerase Chain Reaction; Viral Load; Young Adult
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.12.081

•The viral load in hepatitis E virus (HEV) infection is higher in the acute phases of jaundice.•As the HEV IgG response develops, the viral load starts to decline during the course of disease.•Pregnancy seems to modulate this response, keeping a high viral load for a longer period.•A higher viral load is associated with a lower IgG response in HEV-infected pregnant women.•Pregnancy seems to be associated with poorer disease outcomes for acute HEV hepatitis. To determine IgG immune responses and hepatitis E virus (HEV) viral load, and to explore the associations with pregnancy. A total of 121 HEV-infected women (57 pregnant, 64 non-pregnant) were analysed. Quantitative reverse transcription PCR (RT-qPCR) was done for 78 HEV IgM-positive patients to determine viral load, and Sanger sequencing was performed for 62 HEV-RNA-positive patients to confirm genotyping. ELISA was conducted to determine HEV antibody and avidity indices. The HEV genotype was identified as variant 1. Significant negative correlations were observed between log HEV copy number and log hepatitis E virus IgG antibody index in the late acute phase of jaundice for both pregnant women (r = −0.7971, p = 0.0002) and non-pregnant women (r = −0.9117, p = 0.0002). Pregnant women had significantly higher serum log viral copy numbers and lower IgG antibody indices than non-pregnant women in the late acute phase of HEV-induced jaundice (p = 0.0196 and p = 0.0303, respectively). Moreover, pregnant women with acute HEV hepatitis had higher cross-reactive IgG antibodies compared to the non-pregnant women (p = 0.0017). Five patients with HEV hepatitis died, of whom four were pregnant. Pregnancy might be associated with higher viral loads and a lower IgG response in the HEV-induced late acute phase of jaundice.