High prevalence of antibodies against hepatitis E virus in HIV-infected patients with unexplained liver disease

Merchante, Nicolás; Parra-Sánchez, Manuel; Rivero‐Juárez, Antonio; Cifuentes, Celia; Camacho, Ángela; Macı́as, Juan; Martinez-Dueñas, Loreto; Pérez-Navarro, Elisabet; Rivero, Antonio; Pineda, Juan A.

doi:10.1016/j.eimc.2014.10.018

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…Most of the studies investigating HEV viremia have been conducted among smaller-sized samples of HIV-infected patients presenting either elevated liver enzymes, low CD4+ cell counts (<200 cells/mm 3 ), or chronic liver disease. In such studies, the frequency of HEV RNA detection has varied from 0 to 4% (Crum-Cianflone et al, 2012;Hassing et al, 2014;Kaba et al, 2011;Keane et al, 2012;Merchante et al, 2015;Pischke et al, 2015;Rivero-Juarez et al, 2015;Sellier et al, 2011;Sherman et al, 2014). In the present study, eight (2.2%) out of the 360 HIV-infected patients had HEV RNA detectable by qRT-PCR; however, none of the serum samples obtained previously and subsequently remained positive, thereby excluding chronic infection.…”

Section: Discussioncontrasting

confidence: 50%

“…Moreover, none of the serum samples obtained previously and subsequently had a positive result, thereby excluding chronic infection. Studies assessing HIV-infected patients have detected chronic hepatitis in approximately one-third of the viremic cases (Crum-Cianflone et al, 2012;Kaba et al, 2011;Kuniholm et al, 2016;Merchante et al, 2015;Rivero-Juarez et al, 2015;Sellier et al, 2011), mostly associated with severe immunodeficiency (CD4+ cell counts lower than 200 cells/mm 3 ) (Dalton et al, 2009;Debes et al, 2016;Kaba et al, 2011;Kuniholm et al, 2016;Merchante et al, 2015). In the present study, the population assessed had a significant previous immunosuppression history (mean nadir CD4+ cell count <200 cells/mm 3 ); however, at the time of recruitment, the mean CD4+ cell count was higher than 500 cells/mm 3 .…”

Section: Discussionmentioning

confidence: 52%

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Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil

Silva

Oliveira

Mendoza-Sassi

et al. 2019

International Journal of Infectious Diseases

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Background: Hepatitis E virus genotype 3 (HEV-3) infection usually causes self-limited acute hepatitis. In immunosuppressed patients, HEV-3 infection can rapidly progress to chronic hepatitis and cirrhosis. In southern Brazil, data on HEV seroprevalence are scarce. Methods: Testing for HEV RNA and antibodies (anti-HEV) was performed for 320 HIV-infected patients followed at the HIV/AIDS Service of the Federal University of Rio Grande between 2012 and 2013, as well as 281 blood donor samples obtained in 2015. Variables associated with anti-HEV positivity were assessed by multivariable logistic regression analysis. Results: HIV and blood donor groups showed similar HEV seroprevalence (6.7% and 7.1%, respectively). Risk factors associated with anti-HEV detection were older age, marital status, a higher number of sexual partners, poor sanitation, and alcohol use (HIV group), and living in a rural area (blood donors). HEV RNA was detected in eight serum samples from HIV-infected patients and in one blood donor, who was also positive for anti-HEV IgM and IgG. Conclusions: The prevalence rates of HEV infection were comparable between HIV-seropositive patients who were not severely immunocompromised and blood donors. The blood donor's HEV isolate showed high similarity with swine HEV strains from Brazilian herds in the same region, thus indicating a potential risk of foodborne and parenteral transmission via blood transfusion.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 52%

Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil

Silva

Oliveira

Mendoza-Sassi

et al. 2019

International Journal of Infectious Diseases

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“…The investigators hypothesized that alternative infectious agents may cause cross-reactivity of HEV EIAs, resulting in false positives. Other research has demonstrated EIA cross reactivity between EBV and CMV [13–14], hepatitis A [15], and HIV [16–17], suggesting a ‘molecular mimicry’ phenomenon. Our findings of a significant association between HIV and HEV IgM positivity, lack of HEV RNA, and lower rates of HEV EIA positivity among healthy control residents may be suggestive of such a process.…”

Section: Discussionmentioning

confidence: 99%

Serologic evidence for hepatitis E virus infection among patients with undifferentiated acute febrile illness in Kibera, Kenya

Furukawa

Teshale

Cosmas

et al. 2016

Journal of Clinical Virology

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Background Hepatitis E (HEV) is an emerging cause of viral hepatitis mainly transmitted through the fecal-oral route. Residents of the Kibera slum of Nairobi, Kenya are at risk for fecal-orally transmitted infections. Objective To quantify the incidence and prevalence of HEV infection among acute febrile illness (AFI) cases using a population-based infectious disease surveillance network. Study Design Cross-sectional serum samples from AFI case-patients between 2009 and 2012 were matched to the age and gender distribution of the Kibera population and tested by IgM and IgG enzyme immunoassays (EIA) and nucleic acid testing (NAT). Serum from healthy residents was also tested by EIA. Results Of the 482 AFI serum samples tested, 124 (25.7%) and 182 (37.8%) were IgM and IgG reactive, respectively. On multivariate analysis, IgM reactivity was associated with HIV (RR 1.66, 95%CI 1.07, 2.60; p=0.024) while IgG reactivity was associated with increasing age (p<0.001) and HIV (RR 1.93, 95%CI 1.52, 2.46; p<0.001). AFI case-patients were more likely to be IgM (p=0.002) and IgG (p<0.001) reactive compared to healthy residents. The seroincidence by HEV-specific IgM was 84.0 per 1,000 person years, however, all 482 samples were negative by NAT. Conclusions Serologic evidence for HEV in Kibera suggests a high burden of infection, but NAT did not confirm HEV viremia. Additional testing is needed to determine whether EIAs are susceptible to false positivity in undifferentiated AFI populations before their widespread use.

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“…In immunocompromised individuals, infection with human immunodeficiency virus (HIV) correlation with long‐term complications by HEV infection is less well established . Most studies have found a higher seroprevalence of HEV in HIV‐infected patients, but there is less convincing evidence of chronicity . Interestingly nonetheless, several studies found an increased seroprevalence of HEV in cirrhotics with HIV, compared to HIV‐infected non‐cirrhotic patients, implicating the virus as a potential risk factor for progression of liver disease to advanced fibrosis stages in this setting .…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Most studies have found a higher seroprevalence of HEV in HIV-infected patients, but there is less convincing evidence of chronicity. 9,11,12 Interestingly nonetheless, several studies found an increased seroprevalence of HEV in cirrhotics with HIV, compared to HIV-infected non-cirrhotic patients, implicating the virus as a potential risk factor for progression of liver disease to advanced fibrosis stages in this setting. 13,14 Overall, there is a paucity of knowledge in regard to risk factors that affect prevalence or predispose to HEV infection in individuals with HIV.…”

Section: Introductionmentioning

confidence: 99%

A mutation in the progesterone receptor predisposes to HEV infection in HIV‐positive patients

Debes

Pas

Groothuismink

et al. 2018

Liver International

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Background and AimsInfection with Hepatitis E virus (HEV) can cause chronic liver disease in immunocompromised hosts. In transplant recipients, the use of certain immunosuppressants and food habits has been proposed as risk factors for HEV. In individuals infected with the human immunodeficiency virus (HIV), risk factors for HEV infection are less clear. We aimed to study the association between a mutation in the progesterone receptor (PR) named PROGINS and HEV‐infected in HIV‐positive individuals.MethodsWe evaluated the presence of the SNP PROGINS via KASP in serum samples of 64 HIV‐positive individuals and 187 healthy controls. We performed ELISA tests to address the serum levels of IL‐10 and IL‐12, as well as T‐cell stimulation assays in peripheral blood to address immune response in individuals with PROGINS.ResultsWe found a significant association between the presence of PROGINS mutation and HEV seroprevalence in individuals infected with HIV (30% in HIV+/HEV+ versus 2% in HIV+/HEV, respectively, P = .009). Moreover, we found that HIV+/HEV+ individuals expressing the PROGINS mutation had lower serum levels of IL‐10 and higher levels of IL‐12. The presence of the mutation led to a reduced response upon stimulation of CD4+ and CD8+ T cells compared to those without the mutation, suggesting an immune modulation associated with PROGINS.ConclusionsOur study identified a mutation in the PR that provides significant insights into mechanisms of HEV infection in immunosuppressed individuals.

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High prevalence of antibodies against hepatitis E virus in HIV-infected patients with unexplained liver disease

Cited by 9 publications

References 24 publications

Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil

Detection and characterization of hepatitis E virus genotype 3 in HIV-infected patients and blood donors from southern Brazil

Serologic evidence for hepatitis E virus infection among patients with undifferentiated acute febrile illness in Kibera, Kenya

A mutation in the progesterone receptor predisposes to HEV infection in HIV‐positive patients

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