Virology Journal (Nov 2017)

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

  • Ananta Shrestha,
  • Anurag Adhikari,
  • Manjula Bhattarai,
  • Ramanuj Rauniyar,
  • Jose D. Debes,
  • André Boonstra,
  • Thupten K. Lama,
  • Mamun Al Mahtab,
  • Amna Subhan Butt,
  • Sheikh Mohammad Fazle Akbar,
  • Nirmal Aryal,
  • Sapana Karn,
  • Krishna Das Manandhar,
  • Birendra Prasad Gupta

DOI
https://doi.org/10.1186/s12985-017-0899-x
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 7

Abstract

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Abstract Background Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal. Methods We prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. All individuals were on antiretroviral therapy and healthy blood donors were used as controls. Results We found a high prevalence of HEV IgG (39.4%) and HEV IgM (15.3%) in HIV-positive subjects when compared to healthy HIV-negative controls: 9.5% and 4.4%, respectively (OR: 6.17, 95% CI 4.42–8.61, p < 0.001 and OR: 3.7, 95% CI 2.35–5.92, p < 0.001, respectively). Individuals residing in the Kathmandu area showed a significantly higher HEV IgG seroprevalance compared to individuals residing outside of Kathmandu (76.8% vs 11.1%, OR: 30.33, 95% CI 18.02–51.04, p = 0.001). Mean CD4 counts, HIV viral load and presence of hepatitis B surface antigen correlated with higher HEV IgM rate, while presence of hepatitis C antibody correlated with higher rate of HEV IgG in serum. Overall, individuals with HEV IgM positivity had higher levels of alanine aminotransferase (ALT) than IgM negative subjects, suggesting active acute infection. However, no specific symptoms for hepatitis were identified. Conclusions HIV-positive subjects living in Kathmandu are at higher risk of acquiring HEV infection as compared to the general population and to HIV-positive subjects living outside Kathmandu.

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