Patients infected with HIV are at high‐risk for hepatitis E virus infection in Spain

Abstract

Hepatitis E virus is responsible for sporadic cases of acute, self-limited viral hepatitis not only in endemic but also in industrialized countries. In addition, some reports confirm that it can cause chronic infection and even cirrhosis in immunosuppressed and also in patients infected with HIV. There are few data about prevalence and incidence of HEV chronic infection in HIV-HEV coinfected individuals in Spain. The aim of this study is to investigate the prevalence of anti-HEV IgG in a representative sample of 448 patients infected with HIV and determine the role of age, gender, and CD4 counts in the detection of anti-HEV IgG antibodies in blood. In addition, the clinical features and ALT levels in relation to the presence of anti-HEV IgM and/or HEV-RNA in the blood of these patients were investigated. Anti-HEV IgG antibodies were detected in serum using a commercial enzyme immunoassay. All positive samples were studied further for the presence of anti-HEV IgM antibodies. In addition, HEV RNA was amplified by reverse transcriptase (RT)-nested PCR in all serum samples with IgM anti-HEV. The overall prevalence of anti-HEV IgG was 10.4% (45/448, 95% C.I. 7.2-12.8%). HEV-RNA was found in only one patient out of the 45 anti-HEV IgG positive samples studied. Regarding to gender and CD4 count, no difference in seroprevalence could be observed. This prevalence data suggest that patients infected with HIV can be considered a risk group for HEV infection and that chronic coinfection HEV-HIV seems to be a very rare event.

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

“…22 Additionally, the anti-HEV seroprevalence found in our study is slightly higher than the 14% seroprevalence reported in a recent study conducted in 448 HIV-infected individuals in Spain. 6 Although variability in the strategy and procedures for serological testing could partly explain these differences, it is well documented that seroprevalence varies between countries and within countries, 23 which may have accounted for these differences in a great extent. Further investigations should clarify if the high anti-HEV seroprevalence in HIV-infected patients with unexplained liver disease found in our study reflects a higher risk for HEV infection in this population or if, alternatively, HEV infection is a potential contributor to liver disease in this setting.…”

“…[1][2][3][4] Epidemiological data from Spain have suggested that HIV may be an independent risk factor for autochthonous HEV. 5,6 In a retrospective study, HEV infection accounted for 4% acute liver abnormalities in HIV-infected individuals. 7 Besides HEV-related unexplained acute elevations of liver enzymes, chronic HEV infection with rapid progression to cirrhosis has been reported in HIV-infected patients.…”

Autochthonous acute hepatitis E: an increasingly frequent diagnosis. Clinical-epidemiological analysis of our experience

“…The chronification of HEV infection has been documented in immune suppressed individuals such as a transplant host receptor, patients receiving chemotherapy, or HIV-infected subjects, among others (12,24). However, a case has recently been reported in Spain involving an immunocompetent patient who developed chronic HEV liver disease and grade III/IV fibrosis in the liver biopsy (25).…”

“…In this regard, the highest prevalence occurs in Catalonia (10), where the presence of anti-HEV IgG has been reported recently in 19.96% of all Catalan donors (11). The estimated prevalence is 18.6% among those exposed to porcine livestock (4) and 10.4% in HIV-infected individuals (12). In the United States the reported prevalence is 6% (13), while in England the prevalence is only 0.04% among donors (7).…”

Acute, Chronic and Fulminant Hepatitis E: Ten Years of Experience (2004-2013)

“…It has been proved that HEV circulates in Spain [2] and the limited incidence of clinical manifestations is due to good hygienic conditions and an appropriate health-care structure. The prevalence of specific IgG type antibodies (anti-HEV IgG) in Spain varies depending on the type of population being studied; thus, 0.6% has been detected in individuals with no risk factors [3], 3.6% in pregnant women [4], 18.6% in pig farm workers [5], and 10.11% in patients infected with HIV [6,7]. Other characteristics of the epidemiology in industrialized countries are that it affects older people, predominantly men and that the transmission route is generally unknown [8].…”