Hepatitis E in men who have sex with men: a systematic review

Background The transmission dynamics of hepatitis E in men who have sex with men (MSM) are poorly understood. We aimed to explore any factors observed in MSM with hepatitis E by systematically reviewing the literature. Methods We searched five databases (PubMed, Embase, CINAHL Plus, MEDLINE and Web of Science Core Collections). The primary author performed an initial screen of citations and abstracts, and two authors independently reviewed full-text manuscripts for eligibility. We only included manuscripts in English that explored at least one risk factor for hepatitis E. The risk of bias was assessed using the Joanna Briggs Institute toolkits. Narrative data were synthesised and tabulated. This review was registered on PROSPERO (ID: CRD42023472303). Results 14 manuscripts were included in this review: two case reports, one case-control study, two cohort studies and nine cross-sectional studies from Italy (n=3), Japan (n=2), France (n=2), Argentina (n=1), Russia (n=1), the USA (n=1), the Netherlands (n=1), Belgium (n=1), Spain (n=1) and Greece (n=1). In total, there were 376 MSM with hepatitis E in this analysis. We have highlighted demographic (bimodal age (16-29 and >40), HIV pre-exposure prophylaxis use, living with HIV) and biological (previous syphilis, hepatitis C and hepatitis A) factors in MSM with previous/current hepatitis E. In five manuscripts, no association was found between MSM and hepatitis E. Conclusion Despite conflicting data, hepatitis E may be sexually transmissible in MSM, and MSM with unexplained jaundice, transaminitis, renal disease or neurological disease should be tested. HIV, hepatitis A (including vaccination), hepatitis C and syphilis testing are required in MSM with hepatitis E. This review provides some insight for future clinical guidelines, public health outbreak control strategies and research.