Background: Hepatitis E virus (HEV) infection is an important cause of acute hepatitis worldwide. In pregnant women, HEV can cause more severe symptoms, with high rates of fatal hepatic failure in endemic countries. However, HEV prevalence and circulation among pregnant women from South America is almost unknown. We aimed to investigate HEV infection in pregnant women for the first time in Argentina. Methods: IgG and IgM anti-HEV antibodies and RNA-HEV were investigated (by ELISA assays and RT-Nested-PCR, respectively) in 202 serum samples from pregnant women collected in the central region of Argentina between 2015 and 2017. A control group of 155 non-pregnant women was included (year 2018). Results: The IgG anti-HEV positivity rate was 8.4% (17/202), higher than the 2.6% (4/155) obtained for the nonpregnant women control group, and showing association between pregnancy and HEV infection (p = 0.023, OR = 3.5, CI95% = 1.1-10.5). Women younger than 25 years old presented higher levels of antibodies, and there were no differences in the prevalences between trimesters of pregnancy. Two samples were reactive for IgM anti-HEV, showing recent infections, although no symptoms were registered in these patients. All samples were negative for RNA-HEV amplification. Conclusions: HEV produces infections in pregnant women from Argentina, alerting health teams to consider it as a possible cause of liver disease.

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Introducción: Los trastornos neurocognitivos asociados con el HIV (HAND, por sus siglas en inglés) son altamente prevalentes entre las personas que viven con el virus. Existen tres categorías: demencia asociada a HIV, deterioro neurocognitivo leve y trastorno cognitivo asintomático. Diferentes pruebas de cribado son utilizadas para detectarlos: HIV Dementia Scale (HDS), International Dementia Scale (IHDS) y Mini Mental Test (MMSE). Objetivo: Identificar mediante tres pruebas la presencia de trastornos cognitivos en pacientes infectados con HIV y su relación con diferentes factores de riesgo. Métodos: Estudio prospectivo analítico. Criterios de exclusión: neuroinfecciones, patologías psiquiátricas, uso de drogas de abuso, alcoholismo, TCE y antecedentes de neurocirugía. Resultados: Se incluyeron 51 pacientes entre 18 y 67 años. La prevalencia de HAND fue 25,5%. Presentaban deterioro neurocognitivo: el 66% HDS, 14% IHDS y 29% MMSE; y demencia el 73% HDS, 29% IHDS y 7% MMSE. Se encontró asociación entre HAND y diferentes factores de riego, como edad, desnutrición, nivel instructivo bajo, ≥ tiempo desde el diagnóstico de la infección, bajo recuento de LTCD4+, carga viral detectable y tiempo de inicio de TARV. El 100% de los pacientes tenía al menos un antirretroviral con alta penetración de la barrera hematoencefálica. Conclusiones: Los diferentes grados de deterioro neurocognitivo variaron según la prueba utilizada. Todos los pacientes tratados tenían en su esquema al menos un antirretroviral que atraviesa la barrera hematoencefálica. Factores de riesgo como edad, bajo nivel educativo, bajo peso, carga viral detectable, menor recuento de LTCD4 y tiempo de inicio TARV se asociaron a diferentes grados de deterioro neurocognitivo.

Background:The hepatitis E virus (HEV) is an important and poorly studied pathogen of worldwide distribution that causes enteric hepatitis. The HEV infection in humans is usually selflimited. However, cases of severe fulminant hepatitis have been reported in pregnant women and immunosuppressed patients.In Argentina, serological evidence of human HEV infection has been described in different geographical regions. In Córdoba, HEV prevalence of 4.4% in general population, 7.3% in HIV + individuals, 5.8% in solid organ transplant patients and 10.2% in hemodialysis patients have been documented. Besides, RNA-HEV detections have been performed and genotype 3 was detected.The aim of this research was to describe the circulation of HEV in pregnant women from Córdoba, know if there were symptomatic cases, analyse risk factors related to the infection, and compare the findings with the non-pregnant control group Methods and materials: A total of 202 serum samples from pregnant women (52 prospective and 150 retrospective samples), and 155 samples from non-pregnant women with the same ages (control group) from Córdoba were analysed for IgG anti-HEV detection. Positive samples were tested for IgM anti-HEV and RNA-HEV. Two samples from pregnant women with acute hepatitis were also analysed for HEV detection.Results: The seropositivity of IgG anti-HEV obtained for pregnant women was 8.4%, higher than the 2.6% obtained in the control group, and association between pregnancy and HEV infection was found (p = 0.023). There were no differences between seropositivity rates according to the trimester of pregnancy, although differences were found among age groups, with the higher prevalence in pregnant women younger than 25 years (16.7%, p = 0.032).From the IgG anti-HEV + patients, 2 presented IgM anti-HEV, although both were asymptomatic. None of these samples were positive for RNA-HEV detection. Conclusion:The present study shows, for the first time, the circulation of HEV in pregnant women from Córdoba, generating data that contributes to improve the surveillance and diagnosis of a virus little known in our environment, and under-diagnosed. These association between pregnancy and HEV infection should alert the local health team to consider this microorganism as an agent of liver disease in pregnant women.