Persisting hepatitis E virus infection leading to liver cirrhosis despite recovery of the immune system in an HIV-infected patient

Ingiliz, Patrick; Mayr, Christoph; Obermeier, Martin; Herbst, Hermann; Polywka, Susanne; Pischke, Sven

doi:10.1016/j.clinre.2016.01.005

Cited by 33 publications

(29 citation statements)

References 12 publications

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“…However, progressive fibrosis is well documented with chronic HEV infection of liver allografts and in other severely immunosuppressed patients. 24,28,[32][33][34]37,39 In conclusion, testing of clinical biopsy material can identify HEV infection directly. This is useful for archival material when stored serum is unavailable, including for research purposes, retrospective diagnosis, determining chronic infection timelines and potentially to identify persistent low-level infection more sensitively under immunosuppression.…”

Section: Discussionmentioning

confidence: 96%

“…The present allograft cases were biased towards early infection by the inclusion of pre‐diagnosis biopsies. However, progressive fibrosis is well documented with chronic HEV infection of liver allografts and in other severely immunosuppressed patients …”

Section: Discussionmentioning

confidence: 99%

“…37 There are few pathological descriptions in other immunosuppressed patients. 38,39 Taken together, HEV infection of immunosuppressed patients can manifest only subtle or non-specific pathological changes initially, which with mild changes to transaminases makes early clinical recognition a challenge.…”

Section: Introductionmentioning

confidence: 99%

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Detection of viral hepatitis E in clinical liver biopsies

et al. 2017

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Detection of viral hepatitis E in clinical liver biopsies

et al. 2017

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“…Recently, it has been demonstrated that HEV infection established under the condition of immunosuppression may persist in HIV infected patients despite improvement of their immune status [78]. …”

Section: Acute and Chronic Hepatitis E In Immunosuppressed Individmentioning

confidence: 99%

Acute Hepatitis E: Two Sides of the Same Coin

Hartl

Wehmeyer

Pischke

2016

Viruses

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The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.

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“…The finding of the present study showed that ALT mean levels among group II and group III patients were higher than that among group I patients. The progression in the liver cirrhosis and damages was caused by increasing ALT levels (23,24). HEV and HDV infections cause increased ALT levels, thus, developing liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Sero - Epidemiology of Hepatitis E and D Infections among HIV - Infected and HIV/HCV - Coinfected Patients in Jahrom, Southern Iran

Shadmand

Baharlou

Shokouh

et al. 2018

Arch Clin Infect Dis

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Background: Co -infection of hepatitis E virus (HEV) and hepatitis D virus (HDV) in human immunodeficiency virus (HIV) infected patients can develop and increase hepatic complications in the world, particularly in developing countries. Objectives: The purpose of this study was to assess and compare the sero -virological prevalence of HEV and HDV in patients bearing HIV infection and HIV/HCV co -infection, as well as their relation to clinical and demographic data. Methods: Cross -sectional study testing IgM/IgG anti -HEV and total antibodies HDV in serum samples belong to 73 HIV infected patients and co -infected HIV -HCV patients were evaluated. Demographic, lifestyle, and laboratory data such as CD4 counts and viral load were prospectively collected on each patient with the HIV infection. Results: There were 26 HEV infected patients IgG positive, two HEV infected patients IgM positive, two HDV infected patients total antibodies positive, and only one HDV infected patient IgM among the 73 HIV infected patients. The prevalence of HDV positive IgG and total anti -HDV among co -infected patients were 2.2% and 2.2%. In addition 18 (69.2%) and 2.2% were positive for anti -HEV IgG and IgM, respectively. Furthermore, HIV viral load among HIV co -infected patients with HEV or HDV were shown higher compared to patients solely infected with only HIV. Also, the numbers of HEV or HDV positive were high in low levels of CD4. Conclusions: According to the results, frequency of occurrence of hepatitis E was higher than hepatitis D in HIV infected patients. Severity of HIV infection and liver damage caused by HEV and HDV infections were in a direct relationship. Hence, HIV and HCV screening should be implemented in HIV -infected patients with liver damage.

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Persisting hepatitis E virus infection leading to liver cirrhosis despite recovery of the immune system in an HIV-infected patient

Cited by 33 publications

References 12 publications

Detection of viral hepatitis E in clinical liver biopsies

Detection of viral hepatitis E in clinical liver biopsies

Acute Hepatitis E: Two Sides of the Same Coin

Sero - Epidemiology of Hepatitis E and D Infections among HIV - Infected and HIV/HCV - Coinfected Patients in Jahrom, Southern Iran

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