Chronic Hepatitis E in HIV Patients: Rapid Progression to Cirrhosis and Response to Oral Ribavirin

Neukam, Karin; Barreiro, Pablo; Macı́as, Juan; Avellón, Ana; Cifuentes, Celia; Martín-Carbonero, Luz; Echevarría, José Manuel; Vargas, Julio; Soriano, Vincent; Pineda, Juan A.

doi:10.1093/cid/cit224

Cited by 100 publications

(80 citation statements)

References 12 publications

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“…However, selective screening is to be recommended in certain circumstances. Recent evidence shows that HEV infection can take a severe or even fatal course resulting in liver failure in immunocompromised, pregnant women or patients with chronic liver disease [123,[125][126][127][128][129]. Since these patients often require blood transfusion, it is prudent that screening for HEV-RNA or at least for anti-HEV IgM in donated blood for these patients should be implemented as soon as possible.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis E virus in the countries of the Middle East and North Africa region: an awareness of an infectious threat to blood safety

2015

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In the MENA region, the role of HEV as an infectious threat to blood safety is under-investigated. More data are needed to quantify the risk of transmission and to assess clinical outcomes. This requires, at least, surveillance screening of donors and recipients for HEV markers using sensitive and specific serological tests. At the present time, serious consideration should be given to selective screening for certain groups of patients (e.g., immunocompromised, pregnant women and others) who commonly require blood transfusion and are at high risk of hepatic failure or chronicity from HEV infection.

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Section: Discussionmentioning

confidence: 99%

Hepatitis E virus in the countries of the Middle East and North Africa region: an awareness of an infectious threat to blood safety

2015

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“…More recent studies focusing on detection of anti-HEV IgM, IgG, or RNA have identified both acute (266,(303)(304)(305)(306)(307)(308)(309)(310)(311)(312)(313) and chronic (266,(268)(269)(270)(271)(272)(273)(274) HEV infections in HIV-positive patients, though it remains unclear whether or not seroprevalence is any greater in people with HIV (272,273,300,309,310,(314)(315)(316)(317)(318). Chronic HEV infections in HIV-positive individuals have been associated with quick progression to cirrhosis (269)(270)(271), though it is not clear whether HEV-linked cryptogenic cirrhosis is more common in HIV-infected individuals than in the general population (310,311,315,319).…”

Section: Immunosuppression and Impaired Viral Clearancementioning

confidence: 99%

Host Immune Status and Response to Hepatitis E Virus Infection

2014

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SUMMARY Hepatitis E virus (HEV), identified over 30 years ago, remains a serious threat to life, health, and productivity in developing countries where access to clean water is limited. Recognition that HEV also circulates as a zoonotic and food-borne pathogen in developed countries is more recent. Even without treatment, most cases of HEV-related acute viral hepatitis (with or without jaundice) resolve within 1 to 2 months. However, HEV sometimes leads to acute liver failure, chronic infection, or extrahepatic symptoms. The mechanisms of pathogenesis appear to be substantially immune mediated. This review covers the epidemiology of HEV infection worldwide, the humoral and cellular immune responses to HEV, and the persistence and protection of antibodies produced in response to both natural infection and vaccines. We focus on the contributions of altered immune states (associated with pregnancy, human immunodeficiency virus [HIV], and immunosuppressive agents used in cancer and transplant medicine) to the elevated risks of chronic infection (in immunosuppressed/immunocompromised patients) and acute liver failure and mortality (among pregnant women). We conclude by discussing outstanding questions about the immune response to HEV and interactions with hormones and comorbid conditions. These questions take on heightened importance now that a vaccine is available.

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“…Many studies have suggested that acute HEV was considered a subclinical and self -limiting disease (34); however, co -infection of HEV with HIV cause chronicity of HEV infection and the period of time in which fibrosis progression occurred was alarmingly short. Thus, in co -infection HEV with HIV, progression to cirrhosis may be even faster than descried in HBV or HCV/HIV co -infection (35). Early diagnosis of HIV and HEV co -infection and starting antiviral therapy can lead to reduce clinical complications and hazardous consequences for the patient and clear HEV.…”

Section: Discussionmentioning

confidence: 99%

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

Shadmand

Baharlou

Shokouh

et al. 2018

Arch Clin Infect Dis

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Background: Co -infection of hepatitis E virus (HEV) and hepatitis D virus (HDV) in human immunodeficiency virus (HIV) infected patients can develop and increase hepatic complications in the world, particularly in developing countries. Objectives: The purpose of this study was to assess and compare the sero -virological prevalence of HEV and HDV in patients bearing HIV infection and HIV/HCV co -infection, as well as their relation to clinical and demographic data. Methods: Cross -sectional study testing IgM/IgG anti -HEV and total antibodies HDV in serum samples belong to 73 HIV infected patients and co -infected HIV -HCV patients were evaluated. Demographic, lifestyle, and laboratory data such as CD4 counts and viral load were prospectively collected on each patient with the HIV infection. Results: There were 26 HEV infected patients IgG positive, two HEV infected patients IgM positive, two HDV infected patients total antibodies positive, and only one HDV infected patient IgM among the 73 HIV infected patients. The prevalence of HDV positive IgG and total anti -HDV among co -infected patients were 2.2% and 2.2%. In addition 18 (69.2%) and 2.2% were positive for anti -HEV IgG and IgM, respectively. Furthermore, HIV viral load among HIV co -infected patients with HEV or HDV were shown higher compared to patients solely infected with only HIV. Also, the numbers of HEV or HDV positive were high in low levels of CD4. Conclusions: According to the results, frequency of occurrence of hepatitis E was higher than hepatitis D in HIV infected patients. Severity of HIV infection and liver damage caused by HEV and HDV infections were in a direct relationship. Hence, HIV and HCV screening should be implemented in HIV -infected patients with liver damage.

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Chronic Hepatitis E in HIV Patients: Rapid Progression to Cirrhosis and Response to Oral Ribavirin

Cited by 100 publications

References 12 publications

Hepatitis E virus in the countries of the Middle East and North Africa region: an awareness of an infectious threat to blood safety

Hepatitis E virus in the countries of the Middle East and North Africa region: an awareness of an infectious threat to blood safety

Host Immune Status and Response to Hepatitis E Virus Infection

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

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