Abstract
BackgroundInfection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal.MethodsWe prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. All individuals were on antiretroviral therapy and healthy blood donors were used as controls.ResultsWe found a high prevalence of HEV IgG (39.4%) and HEV IgM (15.3%) in HIV-positive subjects when compared to healthy HIV-negative controls: 9.5% and 4.4%, respectively (OR: 6.17, 95% CI 4.42–8.61, p < 0.001 and OR: 3.7, 95% CI 2.35–5.92, p < 0.001, respectively). Individuals residing in the Kathmandu area showed a significantly higher HEV IgG seroprevalance compared to individuals residing outside of Kathmandu (76.8% vs 11.1%, OR: 30.33, 95% CI 18.02–51.04, p = 0.001). Mean CD4 counts, HIV viral load and presence of hepatitis B surface antigen correlated with higher HEV IgM rate, while presence of hepatitis C antibody correlated with higher rate of HEV IgG in serum. Overall, individuals with HEV IgM positivity had higher levels of alanine aminotransferase (ALT) than IgM negative subjects, suggesting active acute infection. However, no specific symptoms for hepatitis were identified.ConclusionsHIV-positive subjects living in Kathmandu are at higher risk of acquiring HEV infection as compared to the general population and to HIV-positive subjects living outside Kathmandu.
Highlights
Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immunecompetent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas
The course and severity of HEV infection in Human Immunodeficiency Virus (HIV)-infected subjects is a matter of debate: while some studies report unrecognized self-limiting disease, others report chronic infection and rapid progression to cirrhosis [11, 12]
We addressed HEV infection in a cohort of HIVinfected subjects enrolled in the antiretroviral treatment program of Nepal
Summary
Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immunecompetent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal. Infection with the hepatitis E virus (HEV) is the most frequent cause of acute hepatitis among adults in developing countries with poor sanitation and hygiene [1, 2]. Four genotypes of the virus have been identified with different epidemiological and clinical characteristics and are capable of infecting and causing disease in human [3]. We explored risk factors for HEV infection in HIV-positive subjects and the relationship between immune parameters and characteristics of HEV infection
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