Hepatitis E virus genotype 3 and capsid protein in the blood and urine of immunocompromised patients

J Infect. 2019 Mar;78(3):232-240. doi: 10.1016/j.jinf.2019.01.004. Epub 2019 Jan 17.


Objectives: Hepatitis E virus genotype 3 (HEV3) is responsible for acute and chronic liver disease in solid organ transplant (SOT) recipients. HEV was recently found in the urine of some acutely and chronically genotype 4-infected patients.

Methods: We examined the urinary excretion of HEV3 by 24 consecutive SOT recipients at the acute phase of HEV hepatitis and characterized the excreted virus.

Results: Urinary HEV RNA was detected in 12 (50%) of the 24 transplanted patients diagnosed with HEV hepatitis. Urinary HEV antigen (Ag) was detected in all but one of the patients (96%). The density of RNA-containing HEV particles in urine was low (1.11-1.12 g/cm3), corresponding to lipid-associated virions. The urinary HEV RNA/Ag detected was not associated with impaired kidney function or de novo proteinuria. Finally, there was more HEV Ag in the serum at the acute phase of HEV infection in SOT recipients whose infection became chronic.

Conclusions: HEV3 excreted via the urine of SOT recipients at the acute phase of HEV hepatitis has a lipid envelope. Renal function was not impaired. While urinary HEV Ag was a sensitive indicator of HEV infection, only acute phase serum HEV Ag indicated the development of a chronic infection.

Keywords: HEV ORF2 capsid protein; Hepatitis E virus; Transplantation; Urine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Antigens, Viral / blood
  • Antigens, Viral / urine
  • Female
  • Genotype
  • Hepatitis E / blood
  • Hepatitis E / diagnosis*
  • Hepatitis E / urine
  • Hepatitis E virus / genetics
  • Hepatitis E virus / isolation & purification
  • Humans
  • Immunocompromised Host*
  • Male
  • Middle Aged
  • RNA, Viral / genetics
  • RNA, Viral / urine
  • Transplant Recipients
  • Viral Proteins / blood*
  • Viral Proteins / urine*


  • Antigens, Viral
  • ORF2 protein, Hepatitis E virus
  • RNA, Viral
  • Viral Proteins