Immunological alterations in pregnant women with acute hepatitis E

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Abstract
Background: Infection with hepatitis E virus (HEV) is a major cause of acute viral hepatitis in several developing countries. Although usually self‐limiting and benign, the disease is particularly severe among pregnant women, with mortality rates reaching 15–20%. Methods: Immune parameters among pregnant women with acute hepatitis E (P‐HEV) were investigated and compared with those in non‐pregnant patients with hepatitis E (N‐HEV), and healthy pregnant (PC) and non‐pregnant (NPC) women. Results: Peripheral blood mononuclear cells (PBMC) from P‐HEV patients had lower lymphocyte proliferation response to phytohemagglutinin (PHA) than those in the PC and NPC groups. A positive lymphocyte proliferation response to HEV antigen (HEVAg), a mixture of eight peptides derived from HEV proteins, was observed in 7/19 (37%) P‐HEV patients, 3/9 (33%) N‐HEV patients and only 2/21 (10%) PC and 2/14 (14%) NPC subjects; the stimulation indices in the P‐HEV group were similar to the N‐HEV group and higher than the PC group. Measurement of cytokine production by PBMC in response to PHA and HEVAg showed a reduction in production of T‐helper 1 (Th1) cytokines and an increase in that of Th2 cytokines in the P‐HEV group. Cytokine mRNA levels showed similar changes. Conclusion: These results show the existence of a Th2 bias in pregnant women with acute hepatitis E. The role of this Th2 bias in the greater severity of hepatitis E among pregnant women needs further investigation.