Hepatitis E and jaundice in an HIV-positive pregnant woman

Thoden, Jan; Venhoff, Nils; Miehle, Nikolaus; Klar, Maximilian; Huzly, Daniela; Panther, Elisabeth; Jilg, Nikolaus; Kunze, Mirjam; Warnatz, Klaus

doi:10.1097/qad.0b013e3282f7cb9a

Cited by 27 publications

(20 citation statements)

References 10 publications

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“…Thus, in all three previously reported cases of acute hepatitis E that occurred in HIV-infected patients, CD4 counts were >200/mm 3 , ranging between 246 and 360/mm. 3,[8][9][10] In contrast, in the present case, the mean CD4 count during the thirteen months-follow-up was 134/mm 3 , and CD4 counts remained <210/mm 3 despite immune restoration under highly active antiretroviral therapy. In the recent study by Madejon et al, none of 50 serum samples from HIV-infected patients with CD4 counts <200/ mm 3 (median CD4 count was 23 cells/mm 3 ) were positive for HEV RNA.…”

Section: Evidence-based Opinion How Could You Explain the Evolution Ocontrasting

confidence: 80%

“…10 In all three cases, hepatitis spontaneously resolved within 6 months following its onset, and HEV RNA testing performed in the serum from the two former patients showed its disappearance within this period. In addition, Madejon et al have reported the absence of HEV infection among HIV-positive patients with very low CD4+ T lymphocyte counts or cryptogenic chronic hepatitis.…”

Section: Evidence-based Opinion How Could You Explain the Evolution Omentioning

confidence: 72%

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Hepatitis E in an HIV-infected patient

Colson

Kaba

Moreau

et al. 2009

Journal of Clinical Virology

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Section: Evidence-based Opinion How Could You Explain the Evolution Ocontrasting

confidence: 80%

Section: Evidence-based Opinion How Could You Explain the Evolution Omentioning

confidence: 72%

Hepatitis E in an HIV-infected patient

Colson

Kaba

Moreau

et al. 2009

Journal of Clinical Virology

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“…Although such patients are rare in Europe, an HIV-positive woman in Germany developed fulminant hepatitis from an HEV infection during pregnancy [116]. This patient recovered after her HIV infection was more effectively controlled.…”

Section: Reviewmentioning

confidence: 94%

The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients

Nelson

Kmush

Labrique

2011

Expert Review of Anti-infective Therapy

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Hepatitis E virus (HEV) is an important cause of acute hepatitis in humans worldwide, both as epidemic and sporadic disease. Since the virus was identified in 1983, epidemics have occurred regularly in many countries across South and Southeast Asia when seasonal floods have contaminated drinking water supplies and in Africa during humanitarian crises among refugee populations without access to clean water. In addition, sporadic cases and small clusters of HEV infections have been recognized throughout the world in developed countries over the past couple of decades. This review will focus on emerging evidence of HEV infection as an under-recognized pathogen in Europe, the USA and other industrialized countries. We will discuss some of the issues associated with the recognition, diagnosis and treatment of these sporadic cases. We will also summarize the recent literature on autochthonous HEV infection among populations in developed countries in industrialized Europe, the USA, Japan and other industrialized Asian countries. We will review recent reports of acute and chronic HEV infections among transplant recipients and other immunocompromised individuals including HIV/AIDS patients.

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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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Hepatitis E and jaundice in an HIV-positive pregnant woman

Cited by 27 publications

References 10 publications

Hepatitis E in an HIV-infected patient

Hepatitis E in an HIV-infected patient

The epidemiology of hepatitis E virus infections in developed countries and among immunocompromised patients

Host Immune Status and Response to Hepatitis E Virus Infection

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