HIV, HEV and cirrhosis: evidence of a possible link from eastern Spain

Abstract

ObjectivesThe aim of the study was to assess the seroprevalence of hepatitis E virus (HEV) infection in an HIV-infected population, as determined by HEV immunoglobulin G (IgG) antibodies (anti-HEV). MethodsThe design of the study was cross-sectional. Serum anti-HEV IgG was determined by enzyme immunoassay in 238 HIV-infected patients consecutively attending our out-patient clinic between April and May 2011. In HEV-seropositive patients, HEV RNA was analysed by nested reverse transcriptase-polymerase chain reaction (RT-PCR). Associations between anti-HEV and liver cirrhosis, route of HIV infection, hepatitis B virus (HBV) and hepatitis C virus (HCV) serological markers, age, sex and alanine aminotransferase (ALT) levels were examined by univariate and multivariate analysis. ResultsOne hundred and forty patients (59%) had chronic liver disease (99% were HBV-and/or HCV-coinfected). Liver cirrhosis was detected in 44 individuals (19%). Two hundred and twelve patients (89%) were on antiretroviral treatment; the median CD4 T-cell count was 483 cells/mL [interquartile range (IQR) 313-662 cells/mL] and the HIV viral load was < 25 HIV-1 RNA copies/mL. Overall, 22 patients (9%) were anti-HEV positive. Liver cirrhosis was the only factor independently associated with the presence of anti-HEV, which was documented in 23% of patients with cirrhosis and 6% of patients without cirrhosis (P = 0.002; odds ratio 5.77). HEV RNA was detected in three seropositive patients (14%), two of whom had liver cirrhosis. ConclusionsOur findings show a high prevalence of anti-HEV in HIV-infected patients, strongly associated with liver cirrhosis. Chronic HEV infection was detected in a significant number of HEV-seropositive patients. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection and to assess the role of chronic HEV infection in the pathogeneses of cirrhosis in this population.

Sero - Epidemiology of Hepatitis E and D Infections among HIV - Infected and HIV/HCV - Coinfected Patients in Jahrom, Southern Iran

“…HIV viral load and HEV/HDV antibodies presence among patients were in a direct relationship that was similar with previous studies (26). In addition, HIV load level in group II patients was higher than group I patients.…”

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

“…Av, avian; BEL, Belgium; Hu, human; BBH, best BLAST hit; COL, Colombia; FRA, France; Gbk, GenBank; GER, Germany; ITA, Italy; Mrs, Marseille; Tim, Timone laboratory; USA, United States of America. and in HIV-infected patients according to CD4 count, gender, or HIV transmission mode (18)(19)(20)(21). HEV genotype 3c identified here is among the most frequently described in autochthonous cases in Europe, including France (4,22,23).…”

“…The major complications of autochthonous HEV infection in Europe are fatal outcome, which occurred mostly in patients with underlying liver diseases, and progression to chronicity and cirrhosis (14,17,20,32,(41)(42)(43). HIV-infected patients are at particular risk of both severe outcomes due to frequent liver injury related to hepatitis virus coinfections or antiretroviral-induced toxicity and to HIV-induced immunosuppression (11,15).…”

Chronic Hepatitis E Virus Infection and Treatment

“…However, HEV co-infection in patients with HIV is not common and, to date, less than 20 cases have been documented in the literature, and only a handful have had chronic infection, the majority of these cases become cleared of HEV spontaneously. 4,[62][63][64][65][66][67][68][69][70][71][72] In contrast to recipients of a SOT, the key risk factor that determines the development of chronic infection in HIV patients is a low CD4 count. In the five chronic cases described so far, all had CD4 counts <250 mm 3 .…”

“…[62][63][64][65][66][73][74][75][76][77] One study retrospectively tested for HEV in 194 HIV-positive US military beneficiaries and showed that HEV was the cause of abnormal liver function tests in only 4% of HIV-infected individuals. 65 Serum transaminitis caused by HEV was no more common in this population than in the general population.…”