Increased Hepatitis E Virus Seroprevalence Correlates with Lower CD4+ Cell Counts in HIV-Infected Persons in Argentina

Abstract

Hepatitis E virus (HEV) is a single-stranded RNA virus that can cause hepatitis in an epidemic fashion. HEV usually causes asymptomatic or limited acute infections in immunocompetent individuals, whereas in immunosuppressed individuals such as transplant recipients, HEV can cause chronic infections. The risks and outcomes of HEV co-infection in patients infected with human immunodeficiency virus (HIV) are poorly characterized. We used a third generation immunoassay to measure serum IgG antibodies specific for HEV in 204 HIV-infected individuals from Argentina and a control group of 433 HIV-negative individuals. We found 15 of 204 (7.3%, 95%CI 3.74–10.96%) individuals in the HIV-positive group to have positive HEV IgG levels suggestive of previous infection, compared to 19 of 433 (4.4%, 95% CI 2.5–6.3%) individuals in the HIV-negative control group (p = 0.12). Among HIV-positive individuals, those with HEV seropositivity had lower CD4 counts compared to those that were HEV seronegative (average CD4 count of 234 vs 422 mm3, p = 0.01), indicating that patients with lower CD4 counts were more likely to be HEV IgG positive. Moreover, HEV seropositivity in patients with CD4 counts <200 mm3 was 16%, compared to 4.5% in those with CD4 counts >200 mm3 (p = 0.012). We found a positive PCR result for HEV in one individual. Our study found that increased seroprevalence of HEV IgG correlated with lower CD4 counts in HIV-infected patients in Argentina.

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

“…13 Cumulative exposure over time can explain that increasing age is a risk factor associated with HEV infection both in the HIV-infected and general population. 30,31 Similar to previous studies, 32 were not available in this study.…”

Hepatitis E virus in South America: The current scenario

“…A 10‐year gap in knowledge followed, until 2011, when studies from Argentina, Bolivia, Brazil and Colombia, reported respective HEV prevalences . This wave of studies followed the global reports of chronic hepatitis E virus infection by HEV‐3 in immunosuppressed individuals, especially those with solid organ transplantation as well as the reports of extra‐hepatic manifestations of HEV.…”

“…Brazil and Argentina are the only countries in South America which have reported studies about HEV circulation in immunocompromised populations (Table ) . In Argentina higher circulation of HEV was registered in HIV+ individuals, compared to blood donors (6.6% vs 1.8%), volunteers (35.7% vs 14.3% or 9.5%, depending on the kit used) and general population (7.3% vs 4.4%) .…”

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

“…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 .…”

“…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.…”