Hepatitis E in Australian HIV-infected patients: an under-recognised pathogen?
Michelle K. Yong A C , Emma K. Paige A , David Anderson B D and Jennifer F. Hoy A C EA Department of Infectious Diseases, The Alfred Hospital, Commercial Road, Melbourne, Vic. 3004, Australia.
B Burnet Institute, Commercial Road, Melbourne, Vic. 3004, Australia.
C Department of Medicine, Monash University, Melbourne, Vic. 3004, Australia.
D Department of Immunology, Monash University, Melbourne, Vic. 3004, Australia.
E Corresponding author. Email: Jennifer.Hoy@monash.edu
Sexual Health 11(4) 375-378 https://doi.org/10.1071/SH13198
Submitted: 18 December 2013 Accepted: 30 July 2014 Published: 28 August 2014
Abstract
Background: Hepatitis E virus (HEV) infection has been found to cause chronic hepatitis in HIV-infected patients. In Australia, where HEV is nonendemic, background seroprevalence is reportedly low but has not been evaluated in the HIV-infected population. The study aimed to assess the seroprevalence of HEV in a cohort of HIV-infected patients with normal liver function and in another group with biochemical hepatitis. Methods: Patients were selected from the Victorian HIV Blood and Tissue Storage Bank and stored plasma was tested. Positive HEV antibody specimens were examined for HEV RNA by polymerase chain reaction. Results: A total of 191 HIV patients were tested for HEV by serology. Eight of 100 (8%) HIV-infected patients with normal liver function and 4 of 91 (4.4%) of those with biochemical hepatitis had HEV antibodies. All four patients with abnormal liver function and positive HEV serology were coinfected with hepatitis C and were significantly more likely to have higher median alanine aminotransferase levels (382 vs 139 U L–1, P = 0.01). HEV-positive patients with normal liver function were more likely to be born outside Australia (P = 0.004). Two of four patients with biochemical hepatitis who were seropositive for HEV had detectable HEV RNA. Conclusions: The seroprevalence of HEV in this Australian HIV-infected cohort is higher than the estimated background prevalence in the HIV-negative population. In patients coinfected with hepatitis C, the degree of alanine aminotransferase elevation was significantly worse. HEV may contribute to the development of abnormal liver function.
Additional keywords: acute hepatitis, chronic hepatitis, liver function tests, seroprevalence.
References
[1] Rein DB, Stevens GA, Theaker J, Wittenborn JS, Wiersma ST. The global burden of hepatitis E virus genotypes 1 and 2 in 2005. Hepatology 2012; 55 988–97.| The global burden of hepatitis E virus genotypes 1 and 2 in 2005.Crossref | GoogleScholarGoogle Scholar | 22121109PubMed |
[2] Fujiwara S, Yokokawa Y, Morino K, Hayasaka K, Kawabata M, Shimzu T. Chronic hepatitis E: a review of the literature. J Viral Hepat 2014; 21 78–89.
| Chronic hepatitis E: a review of the literature.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2czhsVOgsA%3D%3D&md5=d671e092e002577a4ade7fe7e1a1f780CAS | 24383921PubMed |
[3] Dalton HR, Bendall RP, Keane FE, Tedder RS, Ijaz S. Persistent carriage of hepatitis E virus in patients with HIV infection. N Engl J Med 2009; 361 1025–7.
| Persistent carriage of hepatitis E virus in patients with HIV infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXhtVyjsrbO&md5=ed5c97b0a4eac03a1dc134fab1907533CAS | 19726781PubMed |
[4] Kamar N, Selves J, Mansuy JM, Ouezzani L, Peron JM, Guitard J, et al Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med 2008; 358 811–7.
| Hepatitis E virus and chronic hepatitis in organ-transplant recipients.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXitFOit7k%3D&md5=43eecca8e4b1a6b8e0436f04ced5a7f2CAS | 18287603PubMed |
[5] Moaven L, Van Asten M, Crofts N, Locarnini SA. Seroepidemiology of hepatitis E in selected Australian populations. J Med Virol 1995; 45 326–30.
| Seroepidemiology of hepatitis E in selected Australian populations.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M3psVGlsA%3D%3D&md5=8ea1b02d4b7c455afcb926b86917be4bCAS | 7775956PubMed |
[6] Cowie BC, Adamopoulos J, Carter K, Kelly H. Hepatitis E infections, Victoria, Australia. Emerg Infect Dis 2005; 11 482–4.
| Hepatitis E infections, Victoria, Australia.Crossref | GoogleScholarGoogle Scholar | 15757573PubMed |
[7] Davern TJ, Chalasani N, Fontana RJ, Hayashi PH, Protiva P, Kleiner DE, et al Acute hepatitis E infection accounts for some cases of suspected drug-induced liver injury. Gastroenterology 2011; 141 1665–72.
| Acute hepatitis E infection accounts for some cases of suspected drug-induced liver injury.Crossref | GoogleScholarGoogle Scholar | 21855518PubMed |
[8] Hu WP, Lu Y, Precioso NA, Chen HY, Howard T, Anderson D, et al Double-antigen enzyme-linked immunosorbent assay for detection of hepatitis E virus-specific antibodies in human or swine sera. Clin Vaccine Immunol 2008; 15 1151–7.
| Double-antigen enzyme-linked immunosorbent assay for detection of hepatitis E virus-specific antibodies in human or swine sera.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXhtVWrsLnP&md5=0bc7ed6d61aa098496ccaf93e481c290CAS | 18495846PubMed |
[9] MP Diagnostics. HEV ELISA 4.0v User Manual. Santa Ana, CA: MP Diagnostics; 2005.
[10] Pischke S, Ho H, Urbanek F, Meyer-Olsen D, Suneetha PV, Manns MP, et al Hepatitis E in HIV-positive patients in a low-endemic country. J Viral Hepat 2010; 17 598–9.
| Hepatitis E in HIV-positive patients in a low-endemic country.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cnmvFygtA%3D%3D&md5=baf8831f734f20acfc6876253cbb5585CAS | 20002566PubMed |
[11] Keane F, Gompels M, Bendall R, Drayton R, Jennings L, Black J, et al Hepatitis E virus coinfection in patients with HIV infection. HIV Med 2012; 13 83–8.
| 1:CAS:528:DC%2BC38XitlKhur8%3D&md5=7cd18364053997dc66198f88c2f2b724CAS | 21819531PubMed |
[12] Balayan MS, Fedorova OE, Mikhailov MI, Rytick PG, Eremin VF, Danilova TI, et al Antibody to hepatitis E virus in HIV-infected individuals and AIDS patients. J Viral Hepat 1997; 4 279–83.
| Antibody to hepatitis E virus in HIV-infected individuals and AIDS patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2svit1Cmug%3D%3D&md5=9aec5cac724e1a3ebeaa3798bcb86e2bCAS | 9278226PubMed |
[13] Colson P, Dhiver C, Gerolami R. Hepatitis E virus as a newly identified cause of acute viral hepatitis during human immunodeficiency virus infection. Clin Microbiol Infect 2008; 14 1176–80.
| Hepatitis E virus as a newly identified cause of acute viral hepatitis during human immunodeficiency virus infection.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXhvVKlsbY%3D&md5=fd47c2dda72fc0ae2ef59d3646e8d5f2CAS | 19046170PubMed |
[14] Jagjit Singh GK, Ijaz S, Rockwood N, Farnworth SP, Devitt E, Atkins M, et al Chronic hepatitis E as a cause for cryptogenic cirrhosis in HIV. J Infect 2011; 66 103–6.
| Chronic hepatitis E as a cause for cryptogenic cirrhosis in HIV.Crossref | GoogleScholarGoogle Scholar | 22166370PubMed |
[15] Colson P, Kaba M, Moreau J, Brouqui P. Hepatitis E in an HIV-infected patient. J Clin Virol 2009; 45 269–71.
| Hepatitis E in an HIV-infected patient.Crossref | GoogleScholarGoogle Scholar | 19757504PubMed |
[16] Madejón A, Vispo E, Bottecchia M, Sánchez-Carrillo M, García-Samaniego J, Soriano V. Lack of hepatitis E virus infection in HIV patients with advanced immunodeficiency or idiopathic liver enzyme elevations. J Viral Hepat 2009; 16 895–6.
| Lack of hepatitis E virus infection in HIV patients with advanced immunodeficiency or idiopathic liver enzyme elevations.Crossref | GoogleScholarGoogle Scholar | 19413691PubMed |
[17] Dalton HR, Bendall R, Ijaz S, Banks M. Hepatitis E: an emerging infection in developed countries. Lancet Infect Dis 2008; 8 698–709.
| Hepatitis E: an emerging infection in developed countries.Crossref | GoogleScholarGoogle Scholar | 18992406PubMed |
[18] Kuniholm MH, Labrique AB, Nelson KE. Should HIV-infected patients with unexplained chronic liver enzyme elevations be tested for hepatitis E virus? Clin Infect Dis 2010; 50 1545–6, author reply 6.
| Should HIV-infected patients with unexplained chronic liver enzyme elevations be tested for hepatitis E virus?Crossref | GoogleScholarGoogle Scholar | 20433358PubMed |
[19] van Welzen BJ, Verduyn Lunel FM, Meindertsma F, Hoepelman AI, Arends JE. Hepatitis E virus as a causative agent of unexplained liver enzyme elevations in HIV-infected patients. J Acquir Immune Defic Syndr 2012; 60 e65–7.
| Hepatitis E virus as a causative agent of unexplained liver enzyme elevations in HIV-infected patients.Crossref | GoogleScholarGoogle Scholar | 22622079PubMed |
[20] Wenzel JJ, Preiss J, Schemmerer M, Huber B, Jilg W. Test performance characteristics of Anti-HEV IgG assays strongly influence hepatitis E seroprevalence estimates. J Infect Dis 2013; 207 497–500.
| Test performance characteristics of Anti-HEV IgG assays strongly influence hepatitis E seroprevalence estimates.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXns1eqsA%3D%3D&md5=245c6d6ca8fcb0e3a403b5ed9298c5e9CAS | 23148290PubMed |
