Hepatitis B and E Co-Primary Infections in an HIV-1-Infected Patient

Bouamra, Yanis; Benali, Souâd; Tissot‐Dupont, Hervé; Tamalet, Catherine; Colson, Philippe

doi:10.1128/jcm.02630-12

Cited by 7 publications

(8 citation statements)

References 50 publications

(58 reference statements)

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“…In particular, it has been proposed that HEV may share transmissions pathways with sexually transmitted pathogens such as HIV. 7 8 This latter observation has a topical clinical interest since it has been recently proved that HEV may produce severe chronic infections in immunocompromised participants, including those infected with HIV. 9 10 …”

Section: Introductionmentioning

confidence: 97%

Epidemiology of HEV in the Mediterranean basin: 10-year prevalence in Italy

et al. 2015

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ObjectivesThe present study is aimed at describing the seroprevalence and exploring potential risk factor(s) for hepatitis E virus (HEV) in participants who voluntarily underwent anti-HIV antibody testing.Study designSeroprevalence study.SettingThe HIV prevention unit at the National Institute for Infectious Diseases Lazzaro Spallanzani, serving as a referral centre for HIV infection in Lazio, an Italian Region with about 5.6 million inhabitants.ParticipantsParticipants are a random sample of all subjects who receive counselling and undergo serological tests for anti-HIV antibody (Ab) between 2002 and 2011.Risk factors and outcomeA set of 16 epidemiological variables (risk factors) were assessed for association with positivity to anti-HEV IgG (outcome).ResultsBetween 2002 and 2011, 27 351 serum specimens and related epidemiological information were collected; of these 1116 were randomly selected and analysed. The overall anti-HEV IgG prevalence was 5.38% (60 out of 1116) with evidence of potential heterogeneity between years of sampling (p=0.055). Multivariate analysis provided evidence that anti-HEV IgG prevalence increases by 4% per year of participants’ age (95% CI 1% to 7%, p=0.002). In addition, men who have sex with men and participants who were born outside Italy have an OR for past HEV infection that is about two times higher than in those who were not (p=0.040 and p=0.027, respectively). Analysis of temporal trend showed that variation of anti-HEV IgG can be well explained by a cubic logistic regression model, which describes the variation of prevalence over time as a fluctuation within a 3-year period (p=0.032).ConclusionsThis study provides new evidence that besides the orofecal and zoonotic routes, intimate contacts between males may be a significant mode of HEV transmission.

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Section: Introductionmentioning

confidence: 97%

Epidemiology of HEV in the Mediterranean basin: 10-year prevalence in Italy

et al. 2015

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“…Suspicion of paracetamol intoxication and autoimmune hepatitis here may have prevented the detection of concurrent hepatitis E. Moreover, the diagnosis of hepatitis E can be jeopardized by concurrent infectious causes of liver cytolysis. Thus, HEV infection was previously detected concurrently with hepatitis B virus (HBV) reactivation (42), primary HBV infection (43), or acute hepatitis A virus infection (44,45). Taken together, previous data support testing for HEV in cases of severe acute liver failure, even when another cause has already been identified.…”

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confidence: 60%

“…Taken together, previous data support testing for HEV in cases of severe acute liver failure, even when another cause has already been identified. Notably, ribavirin therapy was reported in severe HEV-related acute liver failure cases (43,46,47) and was associated with rapid viral clearance and resolution, although it cannot be ascertained if or how it was influential.…”

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confidence: 99%

Fatal Fulminant Hepatitis E Associated with Autoimmune Hepatitis and Excessive Paracetamol Intake in Southeastern France

Doudier¹,

Vencatassin²,

Aherfi³

et al. 2014

J Clin Microbiol

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We present, to our knowledge, the first case of fatal fulminant liver failure associated with hepatitis E virus infection, autoimmune hepatitis, and excessive paracetamol intake, which occurred in a 77-year-old woman. Hepatitis E testing should be performed in severe acute liver failure cases, even when another cause has been identified. CASE REPORTA 77-year-old woman was admitted to an emergency unit for jaundice and fever in Marseille, France, in January 2013. She had a past medical history of autoimmune hepatitis without hepatocellular failure. She was receiving an oral anticoagulant for atrial fibrillation (fluindione, 35 mg/day), insulin for diabetes mellitus, and antihypertensive drugs (rilmenidine [2 mg/day], losartan [100 mg/day], and hydrochlorothiazide [25 mg/day]). Diclofenac/misoprostol (50/0.2 mg/day), tramadol chlorhydrate (225 mg/day), and paracetamol (or acetaminophen; 6.6 g/day) were taken from 1 week until 2 days prior to admission for recent dorsal pain. Physical examination revealed jaundice, drowsiness, and digestive tract hemorrhage, which led to admission of the patient into the intensive care unit. She then developed hepatic encephalopathy and hypovolemic shock within a few hours. Laboratory tests showed severe anemia (a hemoglobin level of 6.9 g/dl), acute renal failure (her creatinine level rose to 227 mol/ liter), and acute liver failure with an alanine aminotransferase activity level of 1,668 IU/liter and a prothrombin index of 10% (Table 1). The serum paracetamol level was 3.5 mg/liter (normal value, Ͻ5 mg/liter), possibly because it was measured Ͼ2 days after the last drug intake. Serological and/or molecular markers of hepatitis A, B, and C virus; Epstein-Barr virus; cytomegalovirus; and human immunodeficiency virus (HIV) infection were negative or indicated past infections. The diagnosis of hepatitis E virus (HEV) infection was based on HEV RNA detection in the patient's serum with an in-house PCR assay (1). Subsequently, anti-HEV IgM and IgG were detected (Adaltis, Rome, Italy). The patient was positive for antinuclear autoantibodies (ANA; titer, 1/640) and anti-smooth-muscle antibodies (ASMA; titer, 1/160) but negative for anti-liver kidney microsomal antibodies. Cerebral and abdominal computed tomography scans revealed no abnormalities. The patient's condition deteriorated rapidly, with hemodynamic instability despite blood transfusions and hemodynamic support, which led to the patient's death 5 days later.The patient's family did not report any travel abroad or contact with travelers within the 10-week period prior to admission or a recent transfusion history. Consumption of cooked pork was reported, but consumption of uncooked pork, shellfish, or unsafe drinking water was not. The HEV strain was of genotype 3, as determined by phylogenetic analyses (1) (Fig. 1). The top BLAST hits against the NCBI GenBank nucleotide sequence database for fragments of HEV genome open reading frame 1 (ORF1) (accession no. KF921518) and ORF2 (KF921517) showed 92%

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“…HEV infection could have been alone a sufficient reason to induce acute liver failure. An antiviral therapy with ribavirin would have been recommended, as it is reported in severe HEV-related acute liver failure (16)(17)(18)(19) to ensure rapid viral clearance and resolution. In the case of this patient, autoimmunity was diagnosed simultaneously, leading to an increased ANA-titer and hypergammaglobulinemia with histologically presence of plasma cells.…”

Section: Discussionmentioning

confidence: 99%

De-Novo Autoimmune Hepatitis with Consecutive Acute Liver Failure Induced by Hepatitis E Infection: A Case Report

et al. 2017

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A 49-year-old male patient was referred to our institution for acute liver failure (ALV). Apart from cholestasis, coagulopathy, and hepatic encephalopathy (HE) I°, laboratory studies revealed a significant increase in liver enzymes with an alanine aminotransferase (ALT) level of 4'108 U/L and an aspartate aminotransferase (AST) level of 3'878 U/l (normal < 50 U/L), a constellation essentially compatible with autoimmune hepatitis (AIH). Work-up of serological markers for hepatitis E (HEV-IgM and PCR) was at the same time positive. Furthermore, the patient was strongly positive for antinuclear autoantibodies (ANA) with a titer of 1:1'280 (normal upper limit 1:80), and also presented hypergammaglobulinemia (immunoglobulin IgG-level of 21.3 g/L; normal 7, 0 -16, 0 g/L). Liver histology demonstrated massive hepatitis and necrosis with the presence of plasma cells. Due to the diagnosis of de-novo autoimmune hepatitis, therapy with steroids was performed despite the evidence of acute HEV-infection. It was of great importance that the patient recovered completely while neither antiviral therapy with ribavirin nor liver transplantation (LT) was necessary in the further course.

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Hepatitis B and E Co-Primary Infections in an HIV-1-Infected Patient

Cited by 7 publications

References 50 publications

Epidemiology of HEV in the Mediterranean basin: 10-year prevalence in Italy

Epidemiology of HEV in the Mediterranean basin: 10-year prevalence in Italy

Fatal Fulminant Hepatitis E Associated with Autoimmune Hepatitis and Excessive Paracetamol Intake in Southeastern France

De-Novo Autoimmune Hepatitis with Consecutive Acute Liver Failure Induced by Hepatitis E Infection: A Case Report

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