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BackgroundInfection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal.MethodsWe prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. All individuals were on antiretroviral therapy and healthy blood donors were used as controls.ResultsWe found a high prevalence of HEV IgG (39.4%) and HEV IgM (15.3%) in HIV-positive subjects when compared to healthy HIV-negative controls: 9.5% and 4.4%, respectively (OR: 6.17, 95% CI 4.42–8.61, p < 0.001 and OR: 3.7, 95% CI 2.35–5.92, p < 0.001, respectively). Individuals residing in the Kathmandu area showed a significantly higher HEV IgG seroprevalance compared to individuals residing outside of Kathmandu (76.8% vs 11.1%, OR: 30.33, 95% CI 18.02–51.04, p = 0.001). Mean CD4 counts, HIV viral load and presence of hepatitis B surface antigen correlated with higher HEV IgM rate, while presence of hepatitis C antibody correlated with higher rate of HEV IgG in serum. Overall, individuals with HEV IgM positivity had higher levels of alanine aminotransferase (ALT) than IgM negative subjects, suggesting active acute infection. However, no specific symptoms for hepatitis were identified.ConclusionsHIV-positive subjects living in Kathmandu are at higher risk of acquiring HEV infection as compared to the general population and to HIV-positive subjects living outside Kathmandu.

The aim of this study was to detect the prevalence of hepatitis E virus (HEV) in healthy blood donors so as to decipher the maintenance of (HEV) reservoir if any. Five hundred and eighty-one blood samples along with clinical information were collected from central blood bank, Kathmandu between February and March 2014. Samples were tested for hepatitis B virus surface antigen, anti-hepatitis C virus antibodies, anti-hepatitis A virus IgM, HEV antigen, HEV viral load and anti-HEV antibodies (IgM and IgG) by ELISA. Only those samples positive with anti-HEV IgM were tested for HEV RNA by reverse transcriptase nested PCR. Age adjusted prevalence of IgM anti HEV and IgG anti HEV were 3.6 and 8.3 % respectively. No significant difference in Median ALT levels was noted between HEV RNA positive and negative subjects. Sequence analysis of HEV shows all genotype belongs to genotype 1a. Phylogenetic analysis shows the virus has homology of 95 % with strain from India and Nepal outbreak of April 2014. This study sheds light on how inter epidemic reservoirs can be maintained in healthy population with asymptomatic cases. This raises an important question regarding nature of HEV as well as its tendency to circulate in blind sight and also cause periodic outbreaks in endemic setting like Kathmandu.Keywords HEV Á Nepal Á Blood donors Hepatitis E virus (HEV) infection is endemic in Kathmandu Valley the capital of Nepal. Four epidemics have been documented so far during 1973, 1981-1982, 1987 and 2005-2006 and variable numbers of sporadic acute hepatitis E occurred in between [4]. There have been decline in number of acute hepatitis E cases in recent years and hepatitis A infection has outnumbered HEV as an etiology of acute hepatitis in adults [3]. What maintains the virus in the population during low incidence period of acute hepatitis is a matter of debate. There are some evidences that rodents may serve as animal reservoirs for HEV [2].Occurrence of HEV viremia in healthy blood donors has been increasingly reported across the globe mainly from Europe [5], and China [1] where genotype 3 and 4 predominate. To explore the possibility of HEV viremia in healthy blood donors of Nepal, we collected blood samples along with demographic data from 581 healthy voluntary blood donors from central blood bank, Kathmandu, Nepal during February-March 2014. Study subjects constituted 401 men and 180 women volunteer blood donors. Median age of the subjects was 35 years (range 18-55). Elevated ALT levels ([40 IU/L) were noted in 81(13.9 %) with median ALT value of 23 IU/l (range 5-98 IU/L). IgG anti-HEV was detected in 56 samples (9.5 %) and IgM anti-HEV was detected in 27 samples 4.6 %). When adjusted for the age the prevalence of IgM anti HEV and IgG anti HEV were 3.6 and 8.3 % respectively. No significant difference in Median ALT levels was noted between HEV

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