Hepatitis E virus hides in male reproductive system

The hepatitis E virus (HEV) seems to persist in the ejaculate of chronically infected men who are immunosuppressed, a recent study has found.

The study included nine HEV patients, of whom three were chronically infected with HEV genotype 3, while the remaining six were immunocompetent and only had acute infections. Stool, urine, ejaculate, and blood samples were collected from all participants and subjected to polymerase chain reaction to characterize virus morphology and genomics.

Two of the three patients with chronic infections repeatedly tested HEV-positive in their ejaculate. Quantitative analysis revealed RNA levels that were >2 logs greater than that in serum samples.

Notably, while ribavirin treatment eliminated HEV viraemia in both patients, their ejaculate samples nevertheless continued to test positive for HEV RNA. In one patient, RNA positivity outlasted viraemia for >9 months.

Over time, viral load increased dramatically in serum, ejaculate, and stool samples drawn from the three chronically infected participants. In contrast, ejaculate samples from six immunocompetent patients did not test positive for HEV RNA, and neither did they show an increase in viral load over time.

“It seems that the virus avoids being eliminated by the human immune response by utilizing the immunological niche of the male reproductive system,” the researchers said.

“Future studies are clearly needed to further elucidate and fully understand the impact of HEV replication in the male reproductive system. In addition, further study of the infectivity of HEV virions derived from different bodily fluids is required,” they noted.