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Alexandrova R, Tsachev I, Kirov P, Abudalleh A, Hristov H, Zhivkova T, Dyakova L, Baymakova M. Hepatitis E Virus (HEV) Infection Among Immunocompromised Individuals: A Brief Narrative Review. Infect Drug Resist 2024; 17:1021-1040. [PMID: 38505248 PMCID: PMC10948336 DOI: 10.2147/idr.s449221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
Hepatitis E virus (HEV) is a single-stranded positive-sense RNA virus that belongs to Hepeviridae family. HEV is the most common cause of acute viral hepatitis worldwide. According to the World Health Organization (WHO), there are estimated 20 million HEV infections worldwide every year, leading to estimated 3.3 million symptomatic cases of HEV infection. The WHO estimates that HEV infection caused approximately 44,000 deaths in 2015, which represents 3.3% of mortality rates due to viral hepatitis. In low-income (LI) countries and lower-middle-income (LMI) countries, HEV is a waterborne infection induced by HEV genotype (gt) 1 and HEV gt 2 that cause large outbreaks and affect young individuals with a high mortality rate in pregnant women from South Asian countries and patients with liver diseases. HEV gt 3, HEV gt 4, and HEV gt 7 are responsible for sporadic infections with zoonotic transmission mainly through the consumption of raw or undercooked meat from different animals. Acute HEV infection is relatively asymptomatic or mild clinical form, in rare cases the disease can be moderate/severe clinical forms and result in fulminant hepatitis or acute liver failure (ALF). Furthermore, HEV infection is associated with extrahepatic manifestations, including renal and neurological clinical signs and symptoms. Pregnant women, infants, older people, immunocompromised individuals, patients with comorbidities, and workers who come into close contact with HEV-infected animals are recognized as major risk groups for severe clinical form of HEV infection and fatal outcome. Chronic HEV infection can occur in immunocompromised individuals with the possibility of progression to cirrhosis.
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Affiliation(s)
- Radostina Alexandrova
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Ilia Tsachev
- Department of Microbiology, Infectious and Parasitic Diseases, Faculty of Veterinary Medicine, Trakia University, Stara Zagora, Bulgaria
| | - Plamen Kirov
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Abedulkadir Abudalleh
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Hristo Hristov
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Tanya Zhivkova
- Department of Pathology, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Lora Dyakova
- Department of Synaptic Signaling and Communication, Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Magdalena Baymakova
- Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
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López-Santaella T, Álvarez Y Muñoz T, Medeiros-Domingo M, Moreno-Espinosa S, Consuelo-Sánchez A, Muñoz-Hernández O, Sarmiento-Silva RE, Sotomayor-González A, Trujillo-Ortega ME, García-Hernández ME, Taboada-Ramírez BI, Arenas-Huertero F. Serological and molecular study of Hepatitis E virus in pediatric patients in Mexico. Ann Hepatol 2021; 19:295-301. [PMID: 31899127 DOI: 10.1016/j.aohep.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Cases of viral hepatitis reported in Mexico are typically identified as hepatitis A, B and C. However, unspecified cases are reported annually. Hepatitis E virus (HEV) is an emergent agent that causes a self-limiting infection that can evolve to chronic in immunosuppressed individuals. In Mexico, HEV genotype 2 is considered endemic, though it's the prevalence is not well known. Therefore, the present study was designed to determine the prevalence of HEV among patients at the "Hospital Infantil de Mexico Federico Gomez". MATERIALS AND METHODS The study included 99 patients, anti-HEV antibody (IgG and IgM) were detected by indirect ELISA and viral genome was identified using RT-PCR technique. Two PCR products of positive cases were sequenced. RESULTS ELISA results were positive in 3% and 6%, for IgG and IgM respectively, 54.5% prevalence was found by PCR. Low lymphocyte count (p<0.05) and malnutrition (p<0.005) were significant factors for high PCR prevalence and could increase the possibility of infection. Two samples were sequenced and confirmed the presence of HEV genotype 3. CONCLUSIONS This report reveals the incidence of HEV in pediatric patients in Mexico. Moreover, the identification of HEV genotype 3 in human samples suggests a potential zoonotic risk that requires further research.
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Affiliation(s)
- Tayde López-Santaella
- Laboratorio de Investigación en Patología Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Teresa Álvarez Y Muñoz
- Laboratorio de Investigación en Patología Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Mara Medeiros-Domingo
- Servicio de Nefrología, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | | | | | - Onofre Muñoz-Hernández
- Dirección de Investigación, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Rosa Elena Sarmiento-Silva
- Departamento de Microbiología e Inmunología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | - Alicia Sotomayor-González
- Departamento de Microbiología e Inmunología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - María Elena Trujillo-Ortega
- Departamento de Medicina y Zootecnia de Cerdos, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Montserrat Elemi García-Hernández
- Departamento de Microbiología e Inmunología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Blanca Itzel Taboada-Ramírez
- Departamento de Genética del Desarrollo y Fisiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Mor. Mexico
| | - Francisco Arenas-Huertero
- Laboratorio de Investigación en Patología Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
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Rivero-Juarez A, Lopez-Lopez P, Frias M, Rivero A. Hepatitis E Infection in HIV-Infected Patients. Front Microbiol 2019; 10:1425. [PMID: 31297100 PMCID: PMC6608679 DOI: 10.3389/fmicb.2019.01425] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/05/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The hepatitis E virus (HEV) represents a major cause of acute hepatitis worldwide. The majority of HEV cases occur in low-income countries, mainly Asia and Africa, where HEV causes large outbreaks associated with the consumption of contaminated water and high mortality in specific populations. In high-income countries, HEV infection is considered a zoonotic disease that is linked to the consumption of contaminated food. Although a high proportion of cases have self-limiting asymptomatic or subclinical infections, immunosuppression may modify the pathogenesis and clinical impact of this emerging disease. RESULTS AND DISCUSSION Here, we review the current knowledge about the epidemiology, diagnosis, clinical manifestations, management and prevention of HEV infection in HIV-infected subjects. CONCLUSIONS Despite the increasing knowledge about the pathogenesis, epidemiology and clinical impact of HEV infection, several major factors are faced by HIV-infected patients, including treatment recommendations, immunization and risk practices.
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Affiliation(s)
- Antonio Rivero-Juarez
- Infectious Diseases Unit, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain
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4
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Risk analysis and seroprevalence of HEV in people living with HIV/AIDS in Brazil. Acta Trop 2019; 189:65-68. [PMID: 30292751 DOI: 10.1016/j.actatropica.2018.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023]
Abstract
Acute Hepatitis E virus (HEV) infection in people living with HIV/AIDS (PLHA) can lead to fulminant hepatic failure, cirrhosis and death. The prevalence of anti-HEV antibodies within this group varies according to the geographical area. However, in South America, studies concerning the detection of HEV in PLHA are rare. Here, we investigated the presence of HEV by serological and molecular detection and evaluated the risk factors associated with infection in PLHA in Pernambuco state, Brazilian Northeast. Serological and molecular detection of HEV was performed in 366 samples of PLHA by ELISA for anti-HEV IgG and RT-PCR, respectively. Anti-HEV IgG prevalence was 4.1% (15/366) and no HEV RNA was detected. Concerning the risk factors, we evaluated, in multivariable analysis, age, years of school, sexual orientation, oral-anal sex, use of injectable drugs and piped water. Among them, only piped water availability could be associated with the HEV infection in PLHA (OR: 0.08; CI 95%: 0.01-0.66; p = 0.0182). This study showed for the first time the association of piped water as protection factor for HEV infection in PLHA. Finally, this is also the first report of HEV seroprevalence in PLHA in the Northeast Brazil.
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No molecular evidence of Hepatitis E infection among patients with HIV in Iran. Med J Islam Repub Iran 2018; 31:135. [PMID: 29951435 PMCID: PMC6014803 DOI: 10.14196/mjiri.31.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Indexed: 11/18/2022] Open
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Zhou S, Ren L, Xia X, Miao Z, Huang F, Li Y, Zhu M, Xie Z, Xu Y, Qian Y, Pan Q, Wang K. Hepatitis E virus infection in HIV-infected patients: A large cohort study in Yunnan province, China. J Med Virol 2018; 90:1121-1127. [PMID: 29457639 DOI: 10.1002/jmv.25060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/07/2018] [Indexed: 12/23/2022]
Abstract
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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Affiliation(s)
- Shiyi Zhou
- Yunnan Institute of Digestive Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China.,Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rooterdam, The Netherlands
| | - Li Ren
- The First People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Xueshan Xia
- Faculty of Life Science and Technology, Center for Molecular Medicine in Yunnan province, Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Zhijiang Miao
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rooterdam, The Netherlands.,Faculty of Life Science and Technology, Center for Molecular Medicine in Yunnan province, Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Fen Huang
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Yunlong Li
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rooterdam, The Netherlands.,Medical Faculty, Kunming University of Science and Technology, Kunming, China
| | - Mei Zhu
- Yunnan Institute of Digestive Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Zhenrong Xie
- Yunnan Institute of Digestive Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yu Xu
- Yunnan Institute of Digestive Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yuan Qian
- The First People's Hospital of Zhaotong City, Zhaotong,, Yunnan Province, China
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rooterdam, The Netherlands
| | - Kunhua Wang
- Yunnan Institute of Digestive Disease, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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Serological and molecular markers of hepatitis E virus infection in HIV-infected patients in Brazil. Arch Virol 2017; 163:43-49. [PMID: 28965214 DOI: 10.1007/s00705-017-3562-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/01/2017] [Indexed: 12/19/2022]
Abstract
In Brazil, the circulation of hepatitis E virus (HEV) has been demonstrated in distinct groups of individuals and some animals, but its prevalence among individuals with human immunodeficiency virus (HIV) infection is unknown. This study aimed to assess the frequency of serological and molecular HEV markers in individuals infected with HIV from São Paulo, Brazil. Serum and plasma samples of 354 HIV-infected patients collected between 2007 and 2013 were included. All samples were tested for anti-HEV IgG and IgM antibodies and HEV RNA. Anti-HEV IgG and IgM antibodies were detected in 10.7% (38/354) and 1.4% (5/354) of the samples, respectively. Both antibodies were detected simultaneously in only two samples. HEV RNA was not detected in any sample. There was no significant correlation of anti-HEV serological status (positivity to anti-HEV IgG and/or IgM) with sex, age, CD4+ T cell count, HIV viral load, antiretroviral therapy, liver enzyme levels, or coinfection with hepatitis B virus and/or hepatitis C virus. Our study provides serological evidence of past and recent HEV infections in HIV-infected patients from São Paulo, Brazil. However, the occurrence of ongoing HEV infection appears be a rare event in this population.
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8
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Liver involvement in human immunodeficiency virus infection. Indian J Gastroenterol 2016; 35:260-73. [PMID: 27256434 DOI: 10.1007/s12664-016-0666-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/01/2016] [Indexed: 02/04/2023]
Abstract
The advances in management of patients with acquired immunodeficiency syndrome (AIDS) with highly effective anti-retroviral therapy (HAART) have resulted in increased longevity of patients with human immunodeficiency virus (HIV) infection. AIDS-related illnesses now account for less than 50 % of the deaths, and liver diseases have emerged as the leading cause of death in patients with HIV infection. Chronic viral hepatitis, drug-related hepatotoxicity, non-alcoholic fatty liver disease, and opportunistic infections are the common liver diseases that are seen in HIV-infected individuals. Because of the shared routes of transmission, co-infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are very common in HIV-infected persons. Hepatitis C is the most common viral hepatitis seen in HIV-infected patients. With the availability of directly acting agents, treatment outcome of HCV is comparable to that seen in non HIV-infected patients. Careful monitoring is required for drug interactions and drug-induced hepatotoxicity and modification of drugs should be done where necessary. The results of liver transplantation in select HIV-infected patients can be comparable with those of HIV-negative patients.
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9
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Liu L, Liu Y, Du Y, Liu C, Li W, Li H, Jia T, Chang L. Analysis of long-term follow-up and examination of pathological liver tissue in chronic hepatitis E. Dig Liver Dis 2016; 48:684-6. [PMID: 27038702 DOI: 10.1016/j.dld.2016.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/16/2015] [Accepted: 02/19/2016] [Indexed: 12/11/2022]
Abstract
Hepatitis E is chronic in immunocompromised patients with HIV infection, organ transplant, or radiation and chemotherapy. General cases are not chronic. Fifty-five cases were collected and followed up for 4-14 years. It was found that chronic hepatitis E is more common in males, but a high degree of inflammatory activity and fibrosis was not evident. After 4-14 years of follow-up observation, cirrhosis or liver cancer did not appear. This is significantly different from the hepatitis B and C viruses. We speculated that the chronic mechanism in the general patients with hepatitis E might be different from that of immunocompromised cases.
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Affiliation(s)
- Li Liu
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China.
| | - Yunhua Liu
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China
| | - Yingrong Du
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China
| | - Chunyun Liu
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China
| | - Weikun Li
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China
| | - Huimin Li
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China
| | - Ting Jia
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China
| | - Lixian Chang
- Department of Hepatopathy, The Third People's Hospital of Kunming City, Kunming, China
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Debes JD, Pisano MB, Lotto M, Re V. Hepatitis E virus infection in the HIV-positive patient. J Clin Virol 2016; 80:102-6. [PMID: 27243210 DOI: 10.1016/j.jcv.2016.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/16/2016] [Indexed: 12/12/2022]
Abstract
Hepatitis E virus (HEV) is a RNA virus that can cause hepatitis. In immunocompetent individuals, infection with HEV usually leads to asymptomatic seroconversion. However, in immunosuppressed patients, such as transplant recipients, HEV can develop into a chronic infection. Studies regarding the seroprevalence and clinical implications of HEV in patients infected with the human immunodeficiency virus (HIV) are conflicting. Levels of CD4 count in blood seem to be the most widely associated risk factor, while other factors such as meat consumption or proximity to animals are less clearly associated with HEV infection. Progression to chronicity, as well as extrahepatic manifestations of HEV seem rare in HIV, and the implications of HEV in liver disease progression are poorly understood in the HIV-infected. In this review we describe the epidemiology, risk factors, and clinical implications of HEV infection in individuals infected with HIV.
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Affiliation(s)
- Jose D Debes
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States, United States.
| | - Maria Belen Pisano
- Instituto de Virología "Dr. J. M. Vanella" Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Argentina
| | - Martin Lotto
- Instituto de Virología "Dr. J. M. Vanella" Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Argentina
| | - Viviana Re
- Instituto de Virología "Dr. J. M. Vanella" Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Argentina
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Fierro NA, Realpe M, Meraz-Medina T, Roman S, Panduro A. Hepatitis E virus: An ancient hidden enemy in Latin America. World J Gastroenterol 2016; 22:2271-2283. [PMID: 26900289 PMCID: PMC4735001 DOI: 10.3748/wjg.v22.i7.2271] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/21/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) infection is a common cause of acute clinical hepatitis worldwide. HEV is an RNA-containing virus and the only member of the genus Hepevirus in the family Hepeviridae. Human HEV is classified into four genotypes widely distributed across the world. The virus is mainly transmitted via the fecal-oral route, and water-borne epidemics have become characteristic of hepatitis E in developing countries, including those in Latin America. The zoonotic potential of HEV is broadly recognized. Thus, there is an urgent need to re-evaluate virus transmission scenarios and to enforce epidemiological surveillance systems. Additionally, it is known that HEV infections, initially defined as self-limiting, can also take chronic courses in immunocompromised patients. Moreover, we recently reported a high seroprevalence of HEV in samples from cirrhotic patients with no other etiological agents present, suggesting the potential role of HEV in the development of chronic liver illness. In this review, HEV genomic variability, transmission, chronic infectious course, zoonotic potential and treatment are discussed. Focus is placed on the impact of HEV infection in Latin America, to support the development of specific control strategies and the handling of this important and typically imperceptible viral infection.
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Rafiei A, Ajami A, Mohammad Mirabi A, Saffar MJ, Amjadi O, Haghshenas MR, Abedian F, Khaje-Enayati P. Serum Levels of Soluble CD26, A Novel Prognostic Marker for Hepatitis E Infection. Jundishapur J Microbiol 2016; 9:e31110. [PMID: 27127593 PMCID: PMC4842250 DOI: 10.5812/jjm.31110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 12/11/2022] Open
Abstract
Background: Even without treatment, most acute hepatitis E virus (HEV) infected patients resolve HEV but sometimes the disease leads to acute liver failure, chronic infection, or extrahepatic symptoms. The mechanisms of HEV pathogenesis appear to be substantially immune mediated. However, the immune responses to HEV are not precisely identified. Objectives: This study aimed to evaluate the Th1/Th2 ratio by investigating serum soluble markers from Th1 and Th2 cells in acute HEV infected patients. Patients and Methods: This case-control study included 35 acute HEV infected patients and 35 age and gender matched anti-HEV negative healthy controls. The serum levels of Interferon (IFN)-γ, IL-4, soluble CD26 (sCD26) and sCD30 were determined by the enzyme-linked immunosorbent assay. Results: The results showed a significant difference in IFN-γ and sCD26 (P < 0.0001 and P = 0.001) yet not IL-4 and sCD30 (P = 0.354 and P = 0.159) between acute HEV patients and controls, respectively. There was a positive direct correlation between serum levels of sCD26 and IFN-γ in acute HEV patients (r = 0.64, P = 0.001). In addition, the ratio of sCD26/sCD30 in the acute HEV group was more than two folds higher than in the HEV negative controls. Conclusions: Acute HEV infection shows a pattern of Th1-type immune response, and the direct significant positive correlation between the serum level of sCD26 and IFN-γ in acute HEV infected patients, suggests that the trend of sCD26 levels is a valuable marker for predicting hepatic inflammation in hepatitis E.
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Affiliation(s)
- Alireza Rafiei
- Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Abolghasem Ajami
- Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Araz Mohammad Mirabi
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Araz Mohammad Mirabi, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-1133543614, E-mail:
| | - Mohammad Jafar Saffar
- Department of Infectious Diseases, Buali Hospital, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Omolbanin Amjadi
- Molecular and Cell Biology Research Center, Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Mohammad Reza Haghshenas
- Molecular and Cell Biology Research Center, Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Farshideh Abedian
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Pouya Khaje-Enayati
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
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Lapa D, Capobianchi MR, Garbuglia AR. Epidemiology of Hepatitis E Virus in European Countries. Int J Mol Sci 2015; 16:25711-43. [PMID: 26516843 PMCID: PMC4632823 DOI: 10.3390/ijms161025711] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/12/2015] [Accepted: 10/16/2015] [Indexed: 12/22/2022] Open
Abstract
Over the last decade the seroprevalence of immunoglobulin (IgG) anti hepatitis E virus (HEV) has been increasing in European countries and shows significant variability among different geographical areas. In this review, we describe the serological data concerning the general population and risk groups in different European countries. Anti-HEV antibody prevalence ranged from 1.3% (blood donors in Italy) to 52% (blood donors in France). Various studies performed on risk groups in Denmark, Moldova and Sweden revealed that swine farmers have a high seroprevalence of HEV IgG (range 13%-51.1%), confirming that pigs represent an important risk factor in HEV infection in humans. Subtypes 3e,f are the main genotypes detected in the European population. Sporadic cases of autochthonous genotype 4 have been described in Spain, France, and Italy. Although most HEV infections are subclinical, in immune-suppressed and transplant patients they could provoke chronic infection. Fulminant hepatitis has rarely been observed and it was related to genotype 3. Interferon and ribavirin treatment was seen to represent the most promising therapy.
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Affiliation(s)
- Daniele Lapa
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Via Portuense 292, Rome 00149, Italy.
| | - Maria Rosaria Capobianchi
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Via Portuense 292, Rome 00149, Italy.
| | - Anna Rosa Garbuglia
- Laboratory of Virology, "Lazzaro Spallanzani" National Institute for Infectious Diseases, Via Portuense 292, Rome 00149, Italy.
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Nouhin J, Barennes H, Madec Y, Prak S, Hou SV, Kerleguer A, Kim S, Pean P, Rouet F. Low frequency of acute hepatitis E virus (HEV) infections but high past HEV exposure in subjects from Cambodia with mild liver enzyme elevations, unexplained fever or immunodeficiency due to HIV-1 infection. J Clin Virol 2015; 71:22-7. [PMID: 26370310 DOI: 10.1016/j.jcv.2015.07.304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/08/2015] [Accepted: 07/26/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND In Cambodia, previous studies conducted on hepatitis E virus (HEV) infection are scant, sometimes old, and showed inconsistent results. Moreover, there is no data about HEV infection in Cambodian HIV-1-infected patients. OBJECTIVES To assess the occurrence of acute HEV infections and the level of past HEV exposure in one Mekong country. STUDY DESIGN Using anti-HEV IgM and HEV RNA detection, we retrospectively investigated the presence of acute HEV infection in 825 individuals, including 350 subjects with or without fever, 300 subjects with or without liver enzyme elevations (LEE) and 175 antiretroviral treatment (ART)-naïve, severely immunocompromised HIV-1-infected patients. The detection of anti-HEV IgG was also performed to assess ancient HEV exposure. RESULTS Nine individuals tested positive for anti-HEV IgM yielding an overall rate of 1.1% (95% confidence interval (CI), 0.5-2.0). We did not find significant differences for anti-HEV IgM rates between subjects with unexplained fevers (1.5%) and those with malaria or dengue-associated fever (1.7%) or non-febrile individuals (0%) (P=0.49), and between subjects with (1.5%) and without (2.0%) LEE (P=0.87). No HIV-infected patient tested positive for anti-HEV IgM. HEV RNA was not detected in all tested plasma specimens (n=578). Overall, the anti-HEV IgG prevalence rate was 30.1% (95% CI, 27.0-33.2). CONCLUSIONS The scarcity of recent HEV infection contrasted with the high level of past HEV exposure. The role of HEV in liver disease is likely minor in Cambodia since no HEV RNA was detected in our studied populations, including HIV-positive patients with severe immunodepression.
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Affiliation(s)
- Janin Nouhin
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Hubert Barennes
- Epidemiology and Public Health Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Yoann Madec
- Unité d'Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France
| | - Sophearot Prak
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Serey Vannak Hou
- Medical Laboratory, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | | | - Saorin Kim
- Malaria Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - Polidy Pean
- Immunology Platform, Pasteur Institute in Cambodia, Phnom Penh, Cambodia
| | - François Rouet
- HIV/Hepatitis Unit, Pasteur Institute in Cambodia, Phnom Penh, Cambodia.
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Prevost B, Lucas FS, Goncalves A, Richard F, Moulin L, Wurtzer S. Large scale survey of enteric viruses in river and waste water underlines the health status of the local population. ENVIRONMENT INTERNATIONAL 2015; 79:42-50. [PMID: 25795193 DOI: 10.1016/j.envint.2015.03.004] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/20/2015] [Accepted: 03/03/2015] [Indexed: 05/18/2023]
Abstract
Although enteric viruses constitute a major cause of acute waterborne diseases worldwide, environmental data about occurrence and viral load of enteric viruses in water are not often available. In this study, enteric viruses (i.e., adenovirus, aichivirus, astrovirus, cosavirus, enterovirus, hepatitis A and E viruses, norovirus of genogroups I and II, rotavirus A and salivirus) were monitored in the Seine River and the origin of contamination was untangled. A total of 275 water samples were collected, twice a month for one year, from the river Seine, its tributaries and the major WWTP effluents in the Paris agglomeration. All water samples were negative for hepatitis A and E viruses. AdV, NVGI, NVGII and RV-A were the most prevalent and abundant populations in all water samples. The viral load and the detection frequency increased significantly between the samples collected the most upstream and the most downstream of the Paris urban area. The calculated viral fluxes demonstrated clearly the measurable impact of WWTP effluents on the viral contamination of the Seine River. The viral load was seasonal for almost all enteric viruses, in accordance with the gastroenteritis recordings provided by the French medical authorities. These results implied the existence of a close relationship between the health status of inhabitants and the viral contamination of WWTP effluents and consequently surface water contamination. Subsequently, the regular analysis of wastewater could serve as a proxy for the monitoring of the human viruses circulating in both a population and surface water.
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Affiliation(s)
- B Prevost
- LEESU (UMR MA 102, Université Paris-Est, Agro ParisTech), Université Paris-Est Créteil, 61, Avenue du Général-de-Gaulle, 94010 Créteil cedex, France
| | - F S Lucas
- LEESU (UMR MA 102, Université Paris-Est, Agro ParisTech), Université Paris-Est Créteil, 61, Avenue du Général-de-Gaulle, 94010 Créteil cedex, France
| | - A Goncalves
- SIAAP, Direction du développement et de la prospective, 82, Avenue Kléber, 92700 Colombes, France
| | - F Richard
- SIAAP, Direction du développement et de la prospective, 82, Avenue Kléber, 92700 Colombes, France
| | - L Moulin
- Eau de Paris, DRDQE, R&D biologie, 33, Avenue Jean Jaurès, 94200 Ivry sur Seinze, France.
| | - S Wurtzer
- Eau de Paris, DRDQE, R&D biologie, 33, Avenue Jean Jaurès, 94200 Ivry sur Seinze, France
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Politou M, Boti S, Androutsakos T, Valsami S, Pittaras T, Kapsimali V. Seroprevalence of hepatitis E in HIV infected patients in Greece. J Med Virol 2015; 87:1517-20. [PMID: 25965115 DOI: 10.1002/jmv.24214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 12/23/2022]
Abstract
HEV infection is an emerging public health problem worldwide Data concerning HEV infection in HIV+ patients in Greece is scare. The aim of the study was to determine HEV seroprevalence in patients with HIV infection in Greece. We studied 243 HIV(+) patients 214 men (88%) and 29 women (12%) with a median age of 45 years (range 19-83) who attended the HIV unit of Pathophysiology Department of Laikon General Hospital in Athens for the presence of anti-HEV IgG antibodies with (EIA) (EIA HEV IgG, Adaltis, Rome, Italy Eighteen/243 patients (7.3%) were positive for HEV IgG antibodies, a seroprevalence that was not different from that described for the blood donors group from Greece There was no difference of the presence of HbsAg, hepatitis C and hepatitis A between the HEV(+) and HEV(-) patients. There was no statistically significant difference between the HEV(+) and HEV(-) group in terms of HIV acquisition, sexual orientation, median duration of HIV infection, ART treatment, or duration of ART. Only the median age of HEV(+) was 52 years (35-78) while that of HEV(-) was 44 years (19-83)(P = 0.03). Only 2/18(11.1%) HEV(+) HIV(+) patients had abnormal ALT and AST values. The seroprevalence of hepatitis E in HIV(+) patients in Greece seems to be the same with that of the general population thus implying that HIV infection is not a risk factor for HEV infection and only age shows a positive correlation with seropositivity.
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Affiliation(s)
- Marianna Politou
- Hematology Laboratory, Blood Bank, Aretaieion Hospital, Athens, Greece
| | - Sofia Boti
- AIDS Unit, Pathophysiology Clinic, Laikon Hospital, Athens, Greece
| | | | - Serena Valsami
- Hematology Laboratory, Blood Bank, Aretaieion Hospital, Athens, Greece
| | - Theodoros Pittaras
- Microbiology Laboratory, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Violetta Kapsimali
- Microbiology Laboratory, Medical School of National and Kapodistrian University of Athens, Athens, Greece
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Ramezani A, Mohraz M, Banifazl M, Aghakhani A. Significance of hepatitis E virus infection in HIV-infected patients: a challenging issue. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(14)60794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kim BS, Lim HS, Lee K, Min YS, Yoon YS, Jeong HS. A survey on the status of hepatitis e virus infection among slaughterhouse workers in South Korea. J Prev Med Public Health 2015; 48:53-61. [PMID: 25652711 PMCID: PMC4322518 DOI: 10.3961/jpmph.14.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 12/24/2014] [Indexed: 12/19/2022] Open
Abstract
Objectives: The seroprevalence of hepatitis E virus (HEV) among high-risk groups overseas is high, but studies in these groups are rare in South Korea. We conducted the present study from April to November 2012 to obtain data on the seroprevalence and associated risk factors for HEV among slaughterhouse workers in South Korea. Methods: Slaughterhouse workers from 80 workplaces nationwide were surveyed in South Korea in 2012. The subjects comprised 1848 cases: 1434 slaughter workers and 414 residual products handlers. By visiting 80 slaughterhouses, which were mixed with 75 of which also performed residual products handling, we conducted a questionnaire survey for risk factors and obtained blood samples in order to determine the seropositivity and seroprevalence of HEV. Anti-HEV IgG and IgM were measured using HEV IgG and IgM enzyme-linked immunospecific assay kits and HEV antigen was measured by reverse transcription polymerase chain reaction (RT-PCR). Results: The seropositivity of anti-HEV IgG was 33.5% (slaughter workers 32.8% and residual products handlers 36.2%), and among the seropositive individuals the seroprevalence of anti-HEV IgM was 0.5% (slaughter workers 0.5%, residual products handlers 0.7%). The response rate of HEV-antigen as measured by RT-PCR was 0.2%. Risk factors significantly related to anti-HEV IgG seropositivity were age, sex , and working duration (slaughter workers only). Conclusions: There were significant risk factors (sex, age, and working duration) for HEV identified in our study. All three positive cases for HEV-antigen by RT-PCR were related to pig slaughter but without statistical significance. To prevent HEV, an educational program and working guidelines may be needed for high risk groups.
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Affiliation(s)
- Byung-Seok Kim
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hyun-Sul Lim
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Kwan Lee
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young-Sun Min
- Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young-Sil Yoon
- Division of Vaccine Research, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Hye-Sook Jeong
- Division of Vaccine Research, Korea Centers for Disease Control and Prevention, Cheongju, Korea
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Merchante N, Parra-Sánchez M, Rivero-Juárez A, Cifuentes C, Camacho Á, Macías J, Martínez-Dueñas L, Pérez-Navarro E, Rivero A, Pineda JA. High prevalence of antibodies against hepatitis E virus in HIV-infected patients with unexplained liver disease. Enferm Infecc Microbiol Clin 2014; 33:532-5. [PMID: 25533742 DOI: 10.1016/j.eimc.2014.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 09/24/2014] [Accepted: 10/17/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To look for evidence of hepatitis E virus (HEV) exposure in HIV-infected patients with unexplained elevations of liver stiffness (LS). METHODS Case-control study conducted in 31 HIV-infected patients with unexplained elevations of LS and in 31 HIV-controls with normal LS, matched by age, sex and CD4 cell-counts. Serum HEV antibodies were tested by two ELISA procedures and by Immunoblot. We defined exposure to HEV as the detection of serum HEV antibodies by at least one of the two ELISA assays, provided that it was confirmed by Immunoblot. A real-time PCR RNA assay was conducted in all plasma samples to identify subjects with active HEV infection. RESULTS Exposure to HEV was demonstrated, according to the criteria used in this study, in 9 (29%) of the cases, whereas it was shown in 5 (16%) of the controls (p=.3). Serum HEV RNA was detected in none of the controls and in only in one case. This patient had a documented chronic hepatitis E with progression to cirrhosis. CONCLUSIONS HEV antibodies are frequently found in HIV-infected patients with unexplained liver disease.
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Affiliation(s)
- Nicolás Merchante
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Manuel Parra-Sánchez
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Antonio Rivero-Juárez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Celia Cifuentes
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Ángela Camacho
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Loreto Martínez-Dueñas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Elisabet Pérez-Navarro
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Antonio Rivero
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain.
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20
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Rivero-Juarez A, Martinez-Dueñas L, Martinez-Peinado A, Camacho A, Cifuentes C, Gordon A, Frias M, Torre-Cisneros J, Pineda JA, Rivero A. High hepatitis E virus seroprevalence with absence of chronic infection in HIV-infected patients. J Infect 2014; 70:624-30. [PMID: 25452042 DOI: 10.1016/j.jinf.2014.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/20/2014] [Accepted: 10/06/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS The seroprevalence of the hepatitis E virus (HEV) and its chronicity rate in the HIV-infected population has not been well established. As a result, the magnitude of this emerging disease in this population cannot be established. METHODS Prospective study that included HIV-infected patients followed up between September 2012 and May 2013. All included patients were tested for anti-HEV IgG/IgM. In patients with confirmed anti-HEV IgG/IgM positivity, RT-PCR was performed. In patients where HEV RNA was amplified, a second RT-PCR assay was performed 6 months later to identify transient or chronic HEV infections. RESULTS Eight hundred and ninety-four HIV-infected patients were enrolled in the study. Of these patients, 399 (44.6%) were monoinfected with HIV; 462 (51.6%) were co-infected with HIV/HCV; 12 (1.3%) were co-infected with HIV/HBV; and 21 (2.3%) were co-infected with HIV/HCV/HBV. In 88 patients, anti-HEV IgG/IgM was detected (seroprevalence: 9.8% [95% CI: 8.02%-11.9%]). In five patients (0.5%; 95% CI: 0.2%-1.2%), HEV RNA was detected; 5.7% (95% CI: 2.1%-12.1%) of the patients were anti-HEV IgG/IgM positive. None of these patients showed detectable HEV RNA six months later. CONCLUSION HEV infection is frequent in HIV-infected patients but developing a chronic HEV infection may be considered an uncommon liver disease in this population.
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Affiliation(s)
- Antonio Rivero-Juarez
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain.
| | - Loreto Martinez-Dueñas
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - Antonio Martinez-Peinado
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - Angela Camacho
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - Celia Cifuentes
- Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario de Valme, Seville, Spain
| | - Ana Gordon
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - Mario Frias
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - Julian Torre-Cisneros
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain
| | - Juan A Pineda
- Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario de Valme, Seville, Spain
| | - Antonio Rivero
- Hospital Universitario Reina Sofia de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Cordoba, Spain.
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Abstract
OBJECTIVES To know the prevalence, incidence and factors associated with hepatitis E virus (HEV) infection in HIV-infected individuals in Spain, as well as to provide information on the natural history of HIV/HEV coinfection. DESIGN Prospective cohort study. METHODS Serum HEV IgG antibodies were tested in 613 HIV-infected patients at baseline and 2 years thereafter. Positive samples were tested for HEV-RNA. In patients with seroconversion, changes in liver function tests, serum HEV IgM antibodies and HEV RNA in samples collected between the baseline and the final time points were analyzed. RESULTS One hundred and sixty-one (26%) patients tested positive for serum HEV IgG antibodies at baseline. HEV exposure was more common in men than in women (28 vs. 18%; P = 0.022) and increased linearly with age: 16, 26 and 44% in younger than 40, from 40 to 49 and older than 50 years, respectively (P = 0.000002). One patient bore the serum HEV-RNA at baseline. Eighteen (4%) HEV-seronegative patients seroconverted during the follow-up. None of the factors predicted seroconversion. One patient with seroconversion developed acute hepatitis and four mild hypertransaminasemia without another apparent cause. No case of seroconversion evolved to chronic HEV infection. Seroreversion was detected in 19% of the HEV-seropositive patients at baseline. Patients with seroreversion showed more commonly CD4 cell counts below 500 cells/μl than those who remained seropositive (77 vs. 46%; P = 0.004). CONCLUSIONS Exposure to HEV among HIV-infected patients in Spain is very common, and this increases with age. Evolution to chronic infection is extremely unusual. Most cases of acute HEV infection seem to be clinically and biochemically unexpressive, therefore going unnoticed.
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Abstract
Hepatitis E virus (HEV) infection is a worldwide disease. An improved understanding of the natural history of HEV infection has been achieved within the last decade. Several reservoirs and transmission modes have been identified. Hepatitis E is an underdiagnosed disease, in part due to the use of serological assays with low sensitivity. However, diagnostic tools, including nucleic acid-based tests, have been improved. The epidemiology and clinical features of hepatitis E differ between developing and developed countries. HEV infection is usually an acute self-limiting disease, but in developed countries it causes chronic infection with rapidly progressive cirrhosis in organ transplant recipients, patients with hematological malignancy requiring chemotherapy, and individuals with HIV. HEV also causes extrahepatic manifestations, including a number of neurological syndromes and renal injury. Acute infection usually requires no treatment, but chronic infection should be treated by reducing immunosuppression in transplant patients and/or the use of antiviral therapy. In this comprehensive review, we summarize the current knowledge about the virus itself, as well as the epidemiology, diagnostics, natural history, and management of HEV infection in developing and developed countries.
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Junaid SA, Agina SE, Abubakar KA. Epidemiology and associated risk factors of hepatitis e virus infection in plateau state, Nigeria. Virology (Auckl) 2014; 5:15-26. [PMID: 25512696 PMCID: PMC4251053 DOI: 10.4137/vrt.s15422] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 12/22/2022] Open
Abstract
A cross-sectional study in Nigeria was undertaken to determine the epidemiology, seroprevalence, and associated risk factors, of hepatitis E virus (HEV). A total of 462 subjects were used for the study, categorized into four groups: apparently healthy persons, pregnant women, HIV positive subjects, and animal handlers. Information was obtained from subjects using interviewer-administered questionnaire. Blood samples were collected and analyzed for HEV antibodies (IgG and IgM) using enzyme-linked immunosorbent assay (ELISA) technique. Results obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0 statistical software. The overall seroprevalence of IgG and IgM was 42.7 and 0.9%, respectively. Animal handlers had the highest seroprevalence (66.7%). The associated risk factors for IgM seroprevalence were rural dwelling (P = 0.039, odds ratio (OR) 3.3, 95% confidence interval (CI) 0.7–15.4), blood transfusion (P < 0.001, OR 9.6, 95% CI 2.6–35.6), attending to animals (P = 0.032, OR 4.9, 95% CI 0.9–26.6), and waste disposal (P < 0.001). Factors associated with IgG were age (P = 0.044), location (P < 0.001), marital status (P < 0.001), formal education (P < 0.001), farming as occupation (P < 0.001), rural dwelling (P = 0.001), waste disposal (P < 0.001), alcohol consumption (P = 0.001, OR 2.4, 95% CI 1.4–4.0), open defecation (P < 0.001, OR 2.9, 95% CI 1.4–5.7), attending to animals (P < 0.001, OR 2.3, 95% CI 1.6–3.4), consuming unwashed fruits/vegetables (P < 0.001, OR 4.2, 95% CI 0.3–54.1), and stream/river as a source of drinking water (P < 0.001, OR 3.6, 95% CI 1.6–7.8). Preventive public health measures should be reinforced among all communities, particularly domestic animal handlers and pregnant women. Potable water should be provided for all communities. Data suggest that HEV remains an under-recognized and significant public health problem, warranting further attention and research.
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Affiliation(s)
- Surajudeen A Junaid
- Applied Microbiology Unit, Department of Plant Science and Technology, Faculty of Natural Sciences, University of Jos, Nigeria. ; Department of Medical Microbiology, Federal College of Veterinary and Medical Laboratory Technology, National Veterinary Research Institute (NVRI), Vom, Nigeria
| | - Samuel E Agina
- Applied Microbiology Unit, Department of Plant Science and Technology, Faculty of Natural Sciences, University of Jos, Nigeria
| | - Khadijah A Abubakar
- Department of Medical Virology, Federal College of Veterinary and Medical Laboratory Technology, National Veterinary Research Institute (NVRI), Vom, Nigeria
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Fujiwara S, Yokokawa Y, Morino K, Hayasaka K, Kawabata M, Shimizu T. Chronic hepatitis E: a review of the literature. J Viral Hepat 2014; 21:78-89. [PMID: 24383921 DOI: 10.1111/jvh.12156] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 07/02/2013] [Indexed: 12/14/2022]
Abstract
In 1978, the first case of hepatitis E was identified as non-A, non-B hepatitis. Hepatitis E virus (HEV) infection is believed to be one of the common causes of enterically transmitted acute hepatitis in developing countries and is rare in developed countries, except in patients with a history of travel. However, an increasing number of chronic HEV infection cases have recently been reported in developed countries. In these countries, immunosuppressed patients with HEV infection, such as organ transplant recipients, human immunodeficiency virus (HIV)-infected patients or patients with haematological malignancies, could develop chronic hepatitis E (CHE) infection. Approximately 60% of HEV infections in immunocompromised patients after solid organ transplantation evolve to CHE without antiviral treatment. Clinical manifestations of CHE are often nonspecific symptoms. Many patients with CHE infection are asymptomatic, but some have jaundice, fatigue, abdominal pain, fever and asthenia. Several extrahepatic manifestations have also been reported. Although chronic HEV infection can result in progressive severe liver failure and cirrhosis, diagnosis is often controversial because of the lack of specific diagnostic criteria. Many CHE cases are diagnosed by HEV RNA-positive serum or stool for >6 months. Immunosuppressive drugs, interferon-alpha and ribavirin have been used for treatment. Diagnostic reverse-transcription polymerase chain reaction is useful for estimating treatment efficacy. Preventive measures for HEV infection have been discussed, while systematic guidelines have not yet been reported.
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Affiliation(s)
- S Fujiwara
- Department of Medicine, Tohoku University School of Medicine, Sendai, Miyagi, Japan
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Moal V, Motte A, Kaba M, Gerolami R, Berland Y, Colson P. Hepatitis E virus serological testing in kidney transplant recipients with elevated liver enzymes in 2007-2011 in southeastern France. Diagn Microbiol Infect Dis 2014; 76:116-8. [PMID: 23608351 DOI: 10.1016/j.diagmicrobio.2013.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 02/05/2013] [Accepted: 02/17/2013] [Indexed: 02/08/2023]
Abstract
Hepatitis E virus (HEV) is an emerging cause of acute and chronic hepatitis in Europe, particularly in solid organ transplant recipients. Anti-HEV IgG/IgM testing in kidney transplant recipients with liver biological disturbances indicated high HEV exposure in our geographical area and led to diagnose HEV infection in 6% of cases.
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Affiliation(s)
- Valérie Moal
- Assistance Publique - Hôpitaux de Marseille, Hôpital Conception, Centre de Néphrologie et Transplantation rénale, 13385, Marseille, France
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Krain LJ, Nelson KE, Labrique AB. Host immune status and response to hepatitis E virus infection. Clin Microbiol Rev 2014; 27:139-65. [PMID: 24396140 PMCID: PMC3910912 DOI: 10.1128/cmr.00062-13] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Lisa J. Krain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenrad E. Nelson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alain B. Labrique
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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27
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Riveiro-Barciela M, Buti M, Homs M, Campos-Varela I, Cantarell C, Crespo M, Castells L, Tabernero D, Quer J, Esteban R, Rodriguez-Frías F. Cirrhosis, liver transplantation and HIV infection are risk factors associated with hepatitis E virus infection. PLoS One 2014; 9:e103028. [PMID: 25068388 PMCID: PMC4113416 DOI: 10.1371/journal.pone.0103028] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 06/26/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute and chronic hepatitis E have been associated with high mortality and development of cirrhosis, particularly in solid-organ recipients and patients infected by human immunodeficiency virus. However, data regarding the epidemiology of hepatitis E in special populations is still limited. AIMS Investigate seroprevalence and possible factors associated with HEV infection in a large cohort of immunosuppressed patients. METHODS Cross-sectional study testing IgG anti-HEV in serum samples from 1373 consecutive individuals: 332 liver-transplant, 296 kidney-transplant, 6 dual organ recipients, 301 non-transplanted patients with chronic liver disease, 238 HIV-infected patients and 200 healthy controls. RESULTS IgG anti-HEV was detected in 3.5% controls, 3.7% kidney recipients, 7.4% liver transplant without cirrhosis and 32.1% patients who developed post-transplant cirrhosis (p<0.01). In patients with chronic liver disease, IgG anti-HEV was also statistically higher in those with liver cirrhosis (2% vs 17.5%, p<0.01). HIV-infected patients showed an IgG anti-HEV rate of 9.2%, higher than those patients without HIV infection (p<0.03). Multivariate analysis showed that the factors independently associated with anti-HEV detection were liver cirrhosis, liver transplantation and HIV infection (OR: 7.6, 3.1 and 2.4). HCV infection was a protective factor for HEV infection (OR: 0.4). CONCLUSIONS HEV seroprevalence was high in liver transplant recipients, particularly those with liver cirrhosis. The difference in anti-HEV prevalence between Liver and Kidney transplanted cases suggests an association with advanced liver disease. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection or whether HEV infection may play a role in the pathogeneses of cirrhosis.
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Affiliation(s)
- Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - María Buti
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
- * E-mail:
| | - María Homs
- Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Isabel Campos-Varela
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen Cantarell
- Nephrology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Manuel Crespo
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - David Tabernero
- Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Josep Quer
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael Esteban
- Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Francisco Rodriguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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28
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Mateos-Lindemann ML, Diez-Aguilar M, Galdamez ALG, Galán JC, Moreno A, Pérez-Gracia MT. Patients infected with HIV are at high-risk for hepatitis E virus infection in Spain. J Med Virol 2013; 86:71-4. [PMID: 24136591 DOI: 10.1002/jmv.23804] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/08/2022]
Abstract
Hepatitis E virus is responsible for sporadic cases of acute, self-limited viral hepatitis not only in endemic but also in industrialized countries. In addition, some reports confirm that it can cause chronic infection and even cirrhosis in immunosuppressed and also in patients infected with HIV. There are few data about prevalence and incidence of HEV chronic infection in HIV-HEV coinfected individuals in Spain. The aim of this study is to investigate the prevalence of anti-HEV IgG in a representative sample of 448 patients infected with HIV and determine the role of age, gender, and CD4 counts in the detection of anti-HEV IgG antibodies in blood. In addition, the clinical features and ALT levels in relation to the presence of anti-HEV IgM and/or HEV-RNA in the blood of these patients were investigated. Anti-HEV IgG antibodies were detected in serum using a commercial enzyme immunoassay. All positive samples were studied further for the presence of anti-HEV IgM antibodies. In addition, HEV RNA was amplified by reverse transcriptase (RT)-nested PCR in all serum samples with IgM anti-HEV. The overall prevalence of anti-HEV IgG was 10.4% (45/448, 95% C.I. 7.2-12.8%). HEV-RNA was found in only one patient out of the 45 anti-HEV IgG positive samples studied. Regarding to gender and CD4 count, no difference in seroprevalence could be observed. This prevalence data suggest that patients infected with HIV can be considered a risk group for HEV infection and that chronic coinfection HEV-HIV seems to be a very rare event.
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29
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Ramezani A, Velayati AA, Khorami-Sarvestani S, Eslamifar A, Mohraz M, Banifazl M, Bidari-Zerehpoosh F, Yaghmaei F, McFarland W, Foroughi M, Keyvani H, Mostafavi E, Aghakhani A. Hepatitis E virus infection in patients infected with human immunodeficiency virus in an endemic area in Iran. Int J STD AIDS 2013; 24:769-74. [PMID: 23970597 DOI: 10.1177/0956462413484457] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Some studies have suggested that hepatitis E virus is more frequent in human immunodeficiency virus (HIV) patients and can progress to chronic infection. We aimed to determine the prevalence of hepatitis E virus antibodies and RNA in a series of 100 HIV-infected patients in Tehran, Iran, with comparison to 52 healthy HIV, hepatitis B and C-negative blood donors as controls. HIV-infected patients were also tested for hepatitis E virus-RNA. Among the HIV-infected patients, 10% had antibodies to hepatitis E virus - a finding not significantly different from the uninfected controls (11.5%). No HIV-infected patients had hepatitis E virus IgM antibodies nor did any have detectable hepatitis E virus-RNA. We found no associations between anti-hepatitis E virus IgG-seropositivity and age, sex, route of HIV acquisition, aminotransferases levels, CD4, antiretroviral therapy, hepatitis B virus and hepatitis C virus co-infection. Hepatitis E virus is relatively prevalent in our HIV-infected patients, although without evidence of chronic infection and no more common than among HIV-negative controls or the general population. For the present, we do not recommend routine screening for hepatitis E virus infection in HIV-infected patients in our moderately endemic region.
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Affiliation(s)
- Amitis Ramezani
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
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30
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Zhou X, de Man RA, de Knegt RJ, Metselaar HJ, Peppelenbosch MP, Pan Q. Epidemiology and management of chronic hepatitis E infection in solid organ transplantation: a comprehensive literature review. Rev Med Virol 2013; 23:295-304. [PMID: 23813631 DOI: 10.1002/rmv.1751] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 12/14/2022]
Abstract
Hepatitis E virus (HEV) infection has emerged as a global public health issue. Although it often causes an acute and self-limiting infection with low mortality rates in the western world, it bears a high risk of developing chronic hepatitis in immunocompromised patients with substantial mortality rates. Organ transplant recipients who receive immunosuppressive medication to prevent rejection are thought to be the main population at risk for chronic hepatitis E. Therefore, there is an urgent need to properly evaluate the clinical impact of HEV in these patients. This article aims to review the prevalence, infection course, and management of HEV infection after solid organ transplantation by performing a comprehensive literature review. In addition, an in-depth emphasis of this clinical issue and a discussion of future development are also presented.
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Affiliation(s)
- Xinying Zhou
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands
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31
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Feldt T, Sarfo FS, Zoufaly A, Phillips RO, Burchard G, van Lunzen J, Jochum J, Chadwick D, Awasom C, Claussen L, Drosten C, Drexler JF, Eis-Hübinger AM. Hepatitis E virus infections in HIV-infected patients in Ghana and Cameroon. J Clin Virol 2013; 58:18-23. [PMID: 23743346 DOI: 10.1016/j.jcv.2013.05.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/30/2013] [Accepted: 05/05/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic hepatitis E virus (HEV) infections have recently been described in HIV-infected patients. Only few data are available for sub-Saharan Africa, where HIV and HEV are highly co-endemic, and where liver pathology is common in HIV-infected individuals. OBJECTIVES To assess the prevalence of HEV viremia, anti-HEV antibodies, and serum aminotransferase levels in HIV patients in Ghana and Cameroon. STUDY DESIGN We retrospectively surveyed a cross-section of patients who were enrolled in cohort studies in Ghana (West Africa), and Cameroon (Central Africa). Plasma samples from 1029 HIV patients from Ghana and 515 patients from Cameroon including 214 children were analyzed for HEV-RNA by two reverse transcription PCR methods. In a subset of 791 patients, anti-HEV IgG and IgM antibodies were analyzed. RESULTS No HEV-RNA was detected in any of the plasma samples of 1544 patients. HEV seroprevalence was high in adult HIV patients from Ghana (45.3%, n=402) and Cameroon (14.2%, n=289), but low in pediatric HIV patients from Cameroon (2.0%, n=100). Elevations of alanine aminotransferase and aspartate aminotransferase levels were common in adult patients from Ghana (20.8% and 25.4%) and Cameroon (38.9% and 69.8%). The prevalence of hepatitis B virus surface antigen was 11.8% and of hepatitis C virus antibodies 2.5% in our adult Cameroonian study population. CONCLUSIONS Acute or chronic HEV infections did not play a role in liver pathology in two HIV cohorts in Ghana and Cameroon. A better understanding of the epidemiology and genotype-specific characteristics of HEV infections in HIV patients in sub-Saharan Africa is needed.
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Affiliation(s)
- Torsten Feldt
- Clinical Research Unit, Bernhard Nocht Institute of Tropical Medicine, Bernhard-Nocht Str. 74, 20359 Hamburg, Germany.
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32
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Parvez MK. Chronic hepatitis E infection: risks and controls. Intervirology 2013; 56:213-6. [PMID: 23689166 DOI: 10.1159/000349888] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 02/12/2013] [Indexed: 12/13/2022] Open
Abstract
Very recently, an unusual clinical presentation with an altered natural history associated with hepatitis E virus (HEV) infection has emerged in high-income industrialized nations. Although HEV infection does not develop into chronicity in general, viremia can persist for long periods of time in immunocompromised solid organ, bone marrow and stem cell transplant patients. Conceivably, the atypical clinical and virological outcomes in these cases could be related to immunosuppressive chemotherapy, resulting in suboptimal HEV-specific immune responses. In the absence of travel to endemic regions, foodborne autochthonous HEV infection due to viral genotypes 3 and 4 has been implicated in the chronic cases. Presently, pegIFN-α-2a and ribavirin, the commonly used drugs to treat chronic viral hepatitis, are proving very promising in hepatitis E patients. Nevertheless, the most-awaited HEV vaccine could be protective in naïve travelers or high-risk group populations. The mechanisms of establishing chronic HEV infection and the disease severity have hitherto not been clearly understood. Therefore, a comprehensive clinical, virological and molecular study is needed to understand and control the disease.
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Affiliation(s)
- Mohammad Khalid Parvez
- Department of Pharmacognosy, King Saud University College of Pharmacy, Riyadh, Saudi Arabia.
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33
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Current world literature. Curr Opin Organ Transplant 2012; 17:688-99. [PMID: 23147911 DOI: 10.1097/mot.0b013e32835af316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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34
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Liver injury in HIV monoinfected patients: should we turn a blind eye to it? Clin Res Hepatol Gastroenterol 2012; 36:441-7. [PMID: 23079114 DOI: 10.1016/j.clinre.2012.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/03/2012] [Accepted: 06/06/2012] [Indexed: 02/04/2023]
Abstract
With the advent of combined antiretroviral therapies, liver diseases have emerged as a key issue in the management of HIV infection. In addition to hepatitis co-infection, a large spectrum of liver diseases can affect the prognosis of HIV infection. Acute or progressive hepatic injuries require an accurate diagnosis for a better clinical management. Here, we provide an overview of the main liver diseases associated with HIV infection, which are not covered by the widely documented field of viral hepatitis co-infection.
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