Detection of Human Pegivirus (HPgV) Infection among Filipino Children with Decompensated Liver Disease Secondary to Biliary Cirrhosis and Liver Transplant Pediatric Patients
Background. Human Pegivirus (HPgV), previously called Hepatitis G virus or GB virus C, is an RNA virus. It can be transmitted vertically (mother to infant), parenterally and sexually. HPgV share common routes of transmission to other viruses such as Hepatitis B virus, Hepatitis C virus and Human Immunodeficiency virus (HIV) thus co-infection is usually observed. Risk groups of HPgV include injection drug users, HIV-positive individuals, multi-transfused patients, hemodialysis patients, hemophiliacs, chronic liver disease patients and organ transplant recipients. The clinical significance of HPgV is not yet established and warrants further studies. Research on HPgV in the Philippines is scarce and has not been updated for over 10 years. There is no published data on HPgV prevalence in Filipino pediatric population specifically among risk groups like multi-transfused children with decompensated liver disease secondary to biliary cirrhosis and liver transplant pediatric patients. The lack of local data warrants conduct of this study.
Objective. To determine the presence of HPgV RNA, HPgV E2 antibody (anti-E2) and HBsAg among Filipino children with decompensated liver disease secondary to biliary cirrhosis (DBC) and liver transplant pediatric patients (LTP).
Methods. Included were 15 children with DBC and 15 LTP recruited from the Section of Pediatric Gastroenterology, Hepatology and Nutrition of the UP PGH. All patients’ sera were tested for HPgV RNA by Real Time RT-PCR, HPgV anti-E2 by Enzyme-linked Immunosorbent Assay (ELISA) and hepatitis B surface antigen (HBsAg) by immunochromatographic test. Twenty age and sex matched children with no history of liver disease and blood transfusion served as controls.
Results. All patient and control samples were negative for HPgV RNA. HPgV anti-E2 was detected in 6 of 15 LTP, 5 of 15 DBC and 1 of 20 controls. HBsAg was detected in 2 of 15 LTP, 5 of 15 DBC and 0 of 20 controls. Four patients (two LTP, two DBC) were positive for both HPgV anti-E2 and HBsAg.
Conclusion. This study showed that a proportion of liver transplant patients and those with decompensated biliary cirrhosis are positive for HPgV anti-E2, which indicates that these individuals previously had HPgV infection but is now resolved. Possible source of infection is infected blood from the blood transfusions, infected transplant organ or infected mother. Since routine HPgV screening is not yet recommended for the general population, blood donors and organ donors, the confirmation of exact source of infection may be difficult. Co-infection with HBsAg was also observed in both risk groups which suggests that at some point in time, these children were infected by both HPgV and HBV and also the possibility of simultaneous infection by the two viruses. This study provides preliminary data on the proportion of HPgV infection in Filipino children belonging to two of the HPgV risk groups. Studies with a larger and more significant sample size to determine HPgV prevalence as well as studies regarding the pathogenicity of HPgV are warranted. As this may provide basis for routine HPgV screening among risk groups and blood donations in the future.