Short article: Association between liver fibrosis and hepatitis E seroprevalence among HIV-positive individuals in Nepal

Abstract

Objective Hepatitis E virus (HEV) seropositivity may confer an increased risk of liver fibrosis in immunosuppressed individuals. We studied this effect in HIV-infected individuals in Nepal, a country hyperendemic for HEV. Participants and methods We prospectively evaluated 200 HIV-positive individuals. Serum samples were tested for components of fibrosis scores and cytokeratin-18. Results Of 200 patients, 43% were HEV-immunoglobulin G+. The mean fibrosis-4 score was 8.02 in the HEV-positive and 1.17 in the HEV-negative group (P<0.001). The mean nonalcoholic fatty liver disease score was 2.12 in the HEV-positive and −2.53 in the HEV-negative group (P=0.02). The mean aminotransferase-platelet ratio index score was 0.37 in the HEV-positive and 0.38 in the HEV-negative group (P=0.9). The mean cytokeratin-18 levels were 119.9 in the HEV-positive group and 158.6 in the HEV-negative group (P=0.08). Conclusion We found higher fibrosis-4 and nonalcoholic fatty liver disease scores in HEV-HIV-positive individuals, suggesting an increased liver fibrosis profile in this group. Further studies using liver stiffness measurements should be carried out.

Assessment of subclinical effects of Hepatitis E virus infection in the United States

“…While these results are somewhat ambiguous, they do not demonstrate a significant risk from seemingly asymptomatic HEV infections causing liver fibrosis. A study conducted in Nepal found a strong positive association between HEV IgG and Fib‐4, but it used a different testing kit, characterized the effects of a different genotype of HEV (HEV‐1) and addressed an HIV‐positive population 15 . In this regard, it should be noted that liver fibrosis scores in the HIV‐positive population should be interpreted with caution, as they rely heavily on platelet count, a clinical variable that can be modified by the sole infection with HIV 15,22 …”

“…13,14 Interestingly, a study in individuals infected with the Human Immunodeficiency Virus (HIV) in Nepal, revealed that those with a history of HEV infection had higher indicators of liver fibrosis as compared to HIV-positive persons who tested negative for HEV. 15 In the United States, HEV infection is thought to be predominantly asymptomatic but there is a paucity of literature on the extent of subclinical manifestations of the disease. 16 Moreover, there is no information on whether subclinical HEV infection can lead to chronic liver damage.…”

“…[12][13][14] Our study found a small association between HEV IgG seropos- addressed an HIV-positive population. 15 In this regard, it should be noted that liver fibrosis scores in the HIV-positive population should be interpreted with caution, as they rely heavily on platelet count, a clinical variable that can be modified by the sole infection with HIV. 15,22 There are several limitations to this study.…”

“…15 In this regard, it should be noted that liver fibrosis scores in the HIV-positive population should be interpreted with caution, as they rely heavily on platelet count, a clinical variable that can be modified by the sole infection with HIV. 15,22 There are several limitations to this study. Firstly, the null findings for inflammation could be explained by HEV IgM not being designed for population surveys; even with good specificity, the positive predictive value of IgM would be low due to the extremely low prevalence of positive IgM.…”

“…Studies in Argentina and Italy have noted elevated serum ALT levels in asymptomatic individuals who were positive for HEV IgM 13,14 . Interestingly, a study in individuals infected with the Human Immunodeficiency Virus (HIV) in Nepal, revealed that those with a history of HEV infection had higher indicators of liver fibrosis as compared to HIV‐positive persons who tested negative for HEV 15 …”