Hepatitis E virus infection in the HIV-positive patient

Debes, José D.; Pisano, María Belén; Lotto-Batista, Martín; Ré, Viviana Elizabeth

doi:10.1016/j.jcv.2016.05.006

Cited by 40 publications

(56 citation statements)

References 64 publications

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“…Prevalences of HAV and HEV infection vary widely among HIV‐positive patients throughout the world, which mainly depends on the local endemicity of HAV and HEV infection . Whereas HAV seroprevalence ranged from 15% to 96% among HIV‐positive patients, HEV seroprevalence was significantly lower with a range between 1% and 45% . According to a seroepidemiological survey of 2,860 HIV‐positive patients around Taiwan during 2012‐2016, baseline HAV seroprevalence was only 21% .…”

Section: Discussionmentioning

confidence: 99%

“…A few studies had shown a higher HEV seroprevalence among MSM, suggesting that fecal‐oral transmission route might be facilitated by oral‐anal sex . However, other studies failed to confirm the association between sexual orientation and HEV infection …”

mentioning

confidence: 99%

“…Human immunodeficiency virus (HIV)‐positive patients have a longer duration of HAV viremia and fecal shedding and a prolonged course of acute hepatitis A . Nevertheless, the influence of HIV infection on HEV infection is not clear despite a higher seroprevalence of HEV among HIV‐positive patients . Hepatitis E is usually self‐limiting within 4‐6 weeks, but immunocompromised patients infected with HEV genotype 3 can develop chronic infection .…”

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confidence: 99%

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Hepatitis E Virus Infections Among Human Immunodeficiency Virus–Positive Individuals During an Outbreak of Acute Hepatitis A in Taiwan

Lin

Sun

et al. 2019

Hepatology

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Hepatitis A virus (HAV) and hepatitis E virus (HEV) share the similar fecal‐oral transmission route. During an outbreak of sexually transmitted acute hepatitis A among men who have sex with men (MSM) worldwide between 2015 and 2017, we investigated the possibility of sexual transmission and related morbidity of HEV infection among human immunodeficiency virus (HIV)‐positive patients. From March 1, 2015 to August 31, 2017, anti‐HEV immunoglobulin G was retrospectively determined among 3,293 HIV‐positive patients, who were mainly MSM (87.6%) with a median CD4 count of 575 cells/μL. Prevalence and incidence of HEV infection were 3.7% (123 of 3,293) and 4.35 per 1,000 person‐years of follow‐up (PYFU), respectively, which were significantly lower compared with those of HAV infection (31.1% [996 of 3,204] and 12.61 per 1,000 PYFU, respectively). The number of patients with HEV infection did not increase with the hepatitis A epidemic. The factor associated with prevalent HEV infection was older age (per 1‐year increase, adjusted odds ratio, 1.07; 95% confidence interval, 1.05‐1.09), but neither sexual orientation nor acquisition of sexually transmitted infections was related to prevalent or incident HEV infection. Among 23 patients with incident HEV infection, 22 patients had viremia caused by HEV genotype 4. No patients had prolonged HEV viremia or clinical symptoms, and only a mild elevation of serum aminotransferase, ranging from 34 to 77 IU/L, was noted. Although 4 patients had hepatitis for a prolonged duration of between 8 and 17 months, no abdominal imaging revealed liver fibrosis or cirrhosis. Conclusion: HEV endemicity remained low among HIV‐positive patients in Taiwan during the outbreak of acute hepatitis A. Our data suggest that sexual transmission of HEV with significant morbidity of HEV infection, if any, is rare in this population.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Hepatitis E Virus Infections Among Human Immunodeficiency Virus–Positive Individuals During an Outbreak of Acute Hepatitis A in Taiwan

Lin

Sun

et al. 2019

Hepatology

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“…The prevalence of HEV in the HIV‐infected population varies tremendously depending on the geographic area, from 1.5% to 70.5% . Furthermore, the clinical outcome whether HEV causes acute or chronic infection in HIV patients also differs among reported studies . In China, HEV infection is endemic and HIV infection is mainly found in Southwest China where Yunnan province is the most affected area.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis E virus infection in HIV‐infected patients: A large cohort study in Yunnan province, China

Zhou

Ren

Xia

et al. 2018

Journal of Medical Virology

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Hepatitis E virus (HEV) infection in immunocompromised patients often results in distinct outcome, compared to the infection in general population. This study aimed to investigate the prevalence, potential risk factors, and clinical features of HEV infection among HIV patients treated with antiretroviral therapy (ART) in Yunnan province, China. A total of 770 HIV-infected patients between May 2015 and February 2016 were enrolled in Yunnan, China. All patients received ART. All plasma samples were tested for anti-HEV IgG, anti-HEV IgM antibodies using ELISA kits, and HEV RNA by real-time qRT-PCR. Association between anti-HEV antibody positivity and demographic, clinical and laboratory measures was assessed in univariate and multivariate logistic regression models. Of the 770 HIV-infected patients, 342 patients (44.42%) were anti-HEV IgG antibody positive, and six patients (0.78%) were anti-HEV IgM antibody positive. None of the patients was HEV RNA positive, as tested in our assays. We found that age, gender, CD4 cell count, WHO stage, marital status, and total cholesterol levels were associated with HEV infection. We report a high seroprevalence rate and several potential risk factors of HEV infection in a large HIV cohort from Yunnan province in China. Further research on identification of the circulating HEV strains and the clinical outcome of this patient population is required.

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“…Progression to chronicity is generally described for pregnant women and immunosuppressed individuals, such as patients recovering form solid organ transplantation [7]. Data for HIV-coinfected patients are contradictory and still under discussion, as extensively reviewed by Debes et al [8,9]. According to the World Health Organization (WHO), each year more than 20 million individuals are newly infected with the HEV [10].…”

Section: Introductionmentioning

confidence: 99%

Mutagenic Effects of Ribavirin on Hepatitis E Virus—Viral Extinction versus Selection of Fitness-Enhancing Mutations

Todt

Wälter

Brown

et al. 2016

Viruses

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Hepatitis E virus (HEV), an important agent of viral hepatitis worldwide, can cause severe courses of infection in pregnant women and immunosuppressed patients. To date, HEV infections can only be treated with ribavirin (RBV). Major drawbacks of this therapy are that RBV is not approved for administration to pregnant women and that the virus can acquire mutations, which render the intra-host population less sensitive or even resistant to RBV. One of the proposed modes of action of RBV is a direct mutagenic effect on viral genomes, inducing mismatches and subsequent nucleotide substitutions. These transition events can drive the already error-prone viral replication beyond an error threshold, causing viral population extinction. In contrast, the expanded heterogeneous viral population can facilitate selection of mutant viruses with enhanced replication fitness. Emergence of these mutant viruses can lead to therapeutic failure. Consequently, the onset of RBV treatment in chronically HEV-infected individuals can result in two divergent outcomes: viral extinction versus selection of fitness-enhanced viruses. Following an overview of RNA viruses treated with RBV in clinics and a summary of the different antiviral modes of action of this drug, we focus on the mutagenic effect of RBV on HEV intrahost populations, and how HEV is able to overcome lethal mutagenesis.

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Hepatitis E virus infection in the HIV-positive patient

Cited by 40 publications

References 64 publications

Hepatitis E Virus Infections Among Human Immunodeficiency Virus–Positive Individuals During an Outbreak of Acute Hepatitis A in Taiwan

Hepatitis E Virus Infections Among Human Immunodeficiency Virus–Positive Individuals During an Outbreak of Acute Hepatitis A in Taiwan

Hepatitis E virus infection in HIV‐infected patients: A large cohort study in Yunnan province, China

Mutagenic Effects of Ribavirin on Hepatitis E Virus—Viral Extinction versus Selection of Fitness-Enhancing Mutations

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