Seroepidemiology of Hepatitis E Virus Infection in an Urban Population in Zambia: Strong Association With HIV and Environmental Enteropathy

Jacobs, Choolwe; Chiluba, Clarance; Phiri, Cynthia M.; Lisulo, Mpala Mwanza; Chomba, Mumba; Hill, Philip C.; Ijaz, Samreen; Kelly, Paul

doi:10.1093/infdis/jit409

Cited by 32 publications

(34 citation statements)

References 24 publications

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“…It is recognized that HEV infections may pose serious threats to pregnant women and fetuses during pregnancy, resulting in congenital defects, spontaneous abortion and even death [Adjei et al, ; Goumba et al, ; Huang et al, ]. Similar to other recently‐published evidence [Singh et al, ; Purcell and Emerson, ; Jacobs et al, ], the present study showed that seroprevalence of HEV infection in the third trimester of pregnancy (18.7%) (95% CI 13.7%–23.4%) is higher than that in the second (15.5%) (95% CI 10.7%–20.3%) or the first trimester (15.3%) (95% CI 12.2%–18.4%) of pregnancy.…”

Section: Discussionsupporting

confidence: 85%

Seroprevalence of hepatitis E virus among pregnant women and control subjects in China

Cong

Sui

Zhang

et al. 2014

Journal of Medical Virology

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Hepatitis E infection, caused by the hepatitis E virus (HEV), is an important global public health concern, with particularly high mortality in pregnant women. China is generally judged to be an HEV-endemic area, but epidemiological data for HEV among pregnant women are limited. Between June 2011 and July 2013, a case-control study was conducted to estimate the seroprevalence and potential risk factors associated with the acquisition of HEV infection by pregnant women in China. Nine-hundred and ninety pregnant women who visited hospitals for antenatal follow-up or medication in Qingdao and Weihai and 965 control subjects matched by age, gender and residence were examined for the presence of anti-HEV IgG and IgM antibodies by enzyme immunoassays. Socio-demographic and behavioral characteristics from the study subjects were obtained. The overall prevalence of anti-HEV IgG in all 1,955 samples was 20.7%. In pregnant women, 16.2% of samples were anti-HEV IgG positive whereas, in control subjects 25.3% of samples were anti-HEV IgG positive, (P < 0.01). For anti-HEV IgM detection, 62 (3.2%) of the 1,955 serum samples were positive and the seroprevalence in pregnant women and control subjects was 2.6% and 3.6%, respectively. Age, contact with cats, contact with pigs and exposure to soil were found to be associated with HEV infection. These findings demonstrated the high prevalence of HEV and the considerable potential for the transmission of HEV infection in pregnant women in China.

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Section: Discussionsupporting

confidence: 85%

Seroprevalence of hepatitis E virus among pregnant women and control subjects in China

Cong

Sui

Zhang

et al. 2014

Journal of Medical Virology

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“…The investigators hypothesized that alternative infectious agents may cause cross-reactivity of HEV EIAs, resulting in false positives. Other research has demonstrated EIA cross reactivity between EBV and CMV [13–14], hepatitis A [15], and HIV [16–17], suggesting a ‘molecular mimicry’ phenomenon. Our findings of a significant association between HIV and HEV IgM positivity, lack of HEV RNA, and lower rates of HEV EIA positivity among healthy control residents may be suggestive of such a process.…”

Section: Discussionmentioning

confidence: 99%

Serologic evidence for hepatitis E virus infection among patients with undifferentiated acute febrile illness in Kibera, Kenya

Furukawa

Teshale

Cosmas

et al. 2016

Journal of Clinical Virology

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Background Hepatitis E (HEV) is an emerging cause of viral hepatitis mainly transmitted through the fecal-oral route. Residents of the Kibera slum of Nairobi, Kenya are at risk for fecal-orally transmitted infections. Objective To quantify the incidence and prevalence of HEV infection among acute febrile illness (AFI) cases using a population-based infectious disease surveillance network. Study Design Cross-sectional serum samples from AFI case-patients between 2009 and 2012 were matched to the age and gender distribution of the Kibera population and tested by IgM and IgG enzyme immunoassays (EIA) and nucleic acid testing (NAT). Serum from healthy residents was also tested by EIA. Results Of the 482 AFI serum samples tested, 124 (25.7%) and 182 (37.8%) were IgM and IgG reactive, respectively. On multivariate analysis, IgM reactivity was associated with HIV (RR 1.66, 95%CI 1.07, 2.60; p=0.024) while IgG reactivity was associated with increasing age (p<0.001) and HIV (RR 1.93, 95%CI 1.52, 2.46; p<0.001). AFI case-patients were more likely to be IgM (p=0.002) and IgG (p<0.001) reactive compared to healthy residents. The seroincidence by HEV-specific IgM was 84.0 per 1,000 person years, however, all 482 samples were negative by NAT. Conclusions Serologic evidence for HEV in Kibera suggests a high burden of infection, but NAT did not confirm HEV viremia. Additional testing is needed to determine whether EIAs are susceptible to false positivity in undifferentiated AFI populations before their widespread use.

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“…The prevalence of HEV in the HIV‐infected population varies tremendously depending on the geographic area, from 1.5% to 70.5% . Furthermore, the clinical outcome whether HEV causes acute or chronic infection in HIV patients also differs among reported studies .…”

Section: Introductionmentioning

confidence: 99%

Hepatitis E virus infection in HIV‐infected patients: A large cohort study in Yunnan province, China

Zhou

Ren

Xia

et al. 2018

Journal of Medical Virology

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Hepatitis E virus (HEV) infection in immunocompromised patients often results in distinct outcome, compared to the infection in general population. This study aimed to investigate the prevalence, potential risk factors, and clinical features of HEV infection among HIV patients treated with antiretroviral therapy (ART) in Yunnan province, China. A total of 770 HIV-infected patients between May 2015 and February 2016 were enrolled in Yunnan, China. All patients received ART. All plasma samples were tested for anti-HEV IgG, anti-HEV IgM antibodies using ELISA kits, and HEV RNA by real-time qRT-PCR. Association between anti-HEV antibody positivity and demographic, clinical and laboratory measures was assessed in univariate and multivariate logistic regression models. Of the 770 HIV-infected patients, 342 patients (44.42%) were anti-HEV IgG antibody positive, and six patients (0.78%) were anti-HEV IgM antibody positive. None of the patients was HEV RNA positive, as tested in our assays. We found that age, gender, CD4 cell count, WHO stage, marital status, and total cholesterol levels were associated with HEV infection. We report a high seroprevalence rate and several potential risk factors of HEV infection in a large HIV cohort from Yunnan province in China. Further research on identification of the circulating HEV strains and the clinical outcome of this patient population is required.

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Seroepidemiology of Hepatitis E Virus Infection in an Urban Population in Zambia: Strong Association With HIV and Environmental Enteropathy

Cited by 32 publications

References 24 publications

Seroprevalence of hepatitis E virus among pregnant women and control subjects in China

Seroprevalence of hepatitis E virus among pregnant women and control subjects in China

Serologic evidence for hepatitis E virus infection among patients with undifferentiated acute febrile illness in Kibera, Kenya

Hepatitis E virus infection in HIV‐infected patients: A large cohort study in Yunnan province, China

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