Prevalence and risk of hepatitis E virus infection in the HIV population of Nepal

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.

The First Case Report of Acute Symptomatic HEV Genotype 4 Infection in an HIV-positive Patient in Japan

“…However, several reports in the literature have described a low CD4 count (<200 cells/μL) as a suspected predisposing factor for the acquisition of HEV infection (10). On the other hand, other studies have reported that higher CD4 counts are associated with a higher HEV seroprevalence (11,12). Given such divergent results, the risk factors for HEV infection in HIV-positive patients are controversial and no universal consensus has been reached (10).…”

Seroprevalence of anti-hepatitis E antibodies and antigens among HIV-infected patients in Fars Province, southern Iran

“…Boon et al, reported that 47% of HIV-infected patients in Uganda are seropositive for anti-HEV antibodies [ 10 ]. Shrestha et al, reported a high prevalence (39.4%) of anti-HEV antibodies in Nepalian HIV-positive subjects [ 16 ]. Moreover, the seroprevalence of HEV in Nigerian HIV-infected individuals was reported to be 20% [ 17 ].…”

Hepatitis E: Current Status in India and Other Asian Countries

“…2. Different approaches used for the diagnosis of Hepatitis E virus (HEV) 6,[130][131][132][133] infected patients and in general anti-HEV IgG and anti-HEV IgM similarity was 76.8% and 28.8%, respectively, in HIV-positive patients living in Kathmandu as well as outside Kathmandu 92 . An examination of kids with neurological issues, immune deficient kids and healthy kid's sera tests in Russia revealed the higher presence of anti-HEV IgG among immune deficient in contrast with healthy kids.…”