Hepatitis E Virus infection in HIV-infected patients with elevated serum transaminases levels

Abstract

Increases in aminotransferases levels are frequently encountered in HIV-positive patients and often remain unexplained. The role in this setting and natural history of hepatitis E in HIV-infected patients are unknown. The aim of the study was to assess HEV infection in HIV-infected patients attending a Parisian hospital, with a current or previous cryptogenic hepatitis.191 plasma samples collected from 108 HIV-infected patients with elevated aminotransferases levels were retrospectively tested for the presence of hepatitis E virus (HEV) infection markers: anti-HEV IgM antibodies, anti-HEV IgG antibodies, anti-HEV IgG avidity index and plasma HEV RNA.One acute infection, documented by positive tests for anti-HEV IgM antibody, low anti-HEV IgG avidity index and plasma HEV RNA (genotype 3e), and three past infections were diagnosed, without any observed case of persistent infection. The acute hepatitis was benign and resolved spontaneously within two weeks. This infection was probably contracted locally. Acute HEV hepatitis can occur in HIV-infected patients but rarely explains cryptogenic hepatitis, at least in an urban HIV population, regardless geographic origin and CD4 counts.

Host Immune Status and Response to Hepatitis E Virus Infection

“…More recent studies focusing on detection of anti-HEV IgM, IgG, or RNA have identified both acute (266,(303)(304)(305)(306)(307)(308)(309)(310)(311)(312)(313) and chronic (266,(268)(269)(270)(271)(272)(273)(274) HEV infections in HIV-positive patients, though it remains unclear whether or not seroprevalence is any greater in people with HIV (272,273,300,309,310,(314)(315)(316)(317)(318). Chronic HEV infections in HIV-positive individuals have been associated with quick progression to cirrhosis (269)(270)(271), though it is not clear whether HEV-linked cryptogenic cirrhosis is more common in HIV-infected individuals than in the general population (310,311,315,319).…”

Hepatitis E in patients with hepatic disorders and HIV-infected patients in Croatia: is one diagnostic method enough for hepatitis E diagnosis?

“…In contrary, in severely immunosuppressed patients chronic HEV infection could be a cause of persistent alanin aminotransferase (ALT) elevation. So, HEV persistence may be a potential risk of disease progression also in HIVinfected patients [13][14][15][16][17]. HEV infection needs to be considered as a possible cause of unexplained increase in liver enzymes when common viral causes of hepatitis are excluded.…”

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

“…HEV transmission through sexual intercourse between MSM had been suspected in the 1990s but was not confirmed thereafter (19,21,28). Nonetheless, HEV transmission may potentially occur through sexual intercourse between MSM, as demonstrated for HAV or HCV, particularly in HIV-seropositive persons (29)(30)(31), and HEV infection has been described previously in several MSM and a bisexual man infected with HIV (9,17,21,32,33). Here, the patient reported sexual intercourse with several men and concurrently acquired HBV as well as HAV and HIV earlier in his life.…”