Hepatitis E virus in hematopoietic stem cell transplant recipients: A systematic review

Background: In developed countries, Hepatitis E virus (HEV) infections, especially by HEV-3, are frequently associated with asymptomatic infection or self-limiting acute hepatitis, although it has been described as a cause of chronic infection, especially in immunocompromised hots. Hematopoietic stem cell transplant (HSCT) recipients have been recognized as an important risk group for HEV infection due to their prolonged immunosuppression state. Objectives: We aimed to perform a systematic review of published data to evaluate HEV infection prevalence among HSCT recipients. Study Design: Literature search was performed concerning published manuscripts regarding 'hepatitis E virus AND stem cell transplantation' following the Preferred Reporting of Systematic Reviews and MetaAnalyses (PRISMA) guidelines. Statistical analysis was performed using the MetaXL software to estimate the overall prevalence of HEV infection according to the different diagnostic approaches (HEV RNA and anti-HEV IgM and/or IgG detection). Results: A total of 7 manuscripts were included for data analysis, with 6 studies performed in Europe and 1 study in China. Regarding HEV RNA detection, the overall HEV infection prevalence was 1.50% (95% CI: 0.70-2.60). The overall anti-HEV IgM seroprevalence was 2.00% (95% CI: 0.30-4.50), and anti-HEV IgG was 11.4% (95% CI: 1.80-26.3). Conclusions: This systematic review reveals that the overall prevalence of HEV infection in HSCT patients differ according to the diagnostic, thus emphasizing the need of more studies to increase the data regarding prevalence and incidence in HSCT recipients.