Background: Studies have shown Hepatitis E Virus to be a causative agent of acute and chronic hepatitis in severely immunocompromised patients such as organ transplant recipients and person with HIV infection. This study was designed to determine the burden of HEV infection among HIV positive individuals in Nigeria and the effect of HIV treatment on the burden of HEV infection among this group of patients. Methods: Aliquot of plasma samples collected for laboratory investigations such as CD4 enumeration, blood chemistry (AST, ALT, Creatine, Urea) were used to determine the presence of HEV IgG and IgM antibodies using commercially available ELISA. Samples analysed in the study were collected from 180 HIV positive individuals (90 ART naive and 90 ART experienced) attending the ART clinic at the University College Hospital, Ibadan, Nigeria. Results: Twenty two of the 180 (12.2%) samples were positive for either HEV IgG (20/180) or IgM (2/180). The rate of HEV IgG was higher among ART naive individuals and the two IgM positive persons were ART naive. There was no significant difference in the mean CD4 count and mean ALT between HEV seronegative and seropositive individuals (P = 0.8 and 0.2 respectively). Conclusions: The results of this study suggest the need to test for HEV infection in HIV positive individuals for the early diagnosis and proper management since HEV is known to be fulminant in the presence of underlying liver disease that is common among HIV infected persons. In addition, the use of ART may reduce the incidence of HEV infection in HIV positive persons.
KeywordsHEV InfectionHIV PositiveARTNigeria
E. H. Teshale and D. J. Hu, “Hepatitis E: Epidemiology and Prevention,” World Journal of Hepatology, Vol. 3, No. 12, 2011, pp. 285-291.
S. U. Emerson and R. H. Purcell, “Hepatitis E Virus,” Reviews in Medical Virology, Vol. 13, No. 3, 2003, pp. 145-154. doi:10.1002/rmv.384
M, Irshad, “Hepatitis E Virus: An Update on Its Molecular, Clinical and Epidemiological Characteristics,” Intervirology, Vol. 42, No. 4, 1999, pp. 252-262. doi:10.1159/000024985
P. Vasickova, I. Psikal, P. Kralik, F. Widen, Z. Hubalek and I. Pavlik, “Hepatitis E Virus: A Review,” Veterinarni Medicina, Vol. 52, No. 9, 2007, pp. 365-384.
P. Billam, F. F. Huang, Z. F. Sun, F. W. Pierson, R. B. Duncan, F. Elvinger et al., “Systematic Pathogenesis and Replication of Avian Hepatitis E Virus in Specific-Pathogen-Free Adult Chickens,” Journal of Virology, Vol. 80, No. 6721, 2005, pp. 3429-3437. doi:10.1128/JVI.79.6.3429-3437.2005
X. J. Meng, P. G. Halbur, T. S. Tsareva, J. D. Bruna, R. L. Royer, R. H. Purcell and S. U. Emerson, “Experimental Infection of Pigs with the Newly Identified Swine Hepatitis E Virus (Swine HEV), But Not with Human Strain of HEV,” Archives of Virology, Vol. 143, No. 7, 1998, pp. 1405-1415. doi:10.1007/s007050050384
C. Kasorndorkbua, P. G. Halbur, P. J. Thomas, D. K. Guenette, T. E. Toth and X. J. Meng, “Use of a Swine Bioassay and a RT-PCR Assay to Assess the Risk of Transmission of Swine Hepatitis E Virus in Pigs,” Journal of Virological Methods, Vol. 101, No. 1-2, 2002, pp. 71-78.
H. Okamoto, M. Takahashi, T. Nishizawa, R. Usui and E. Kobayashi, “Presence of Antibodies to Hepatitis E Virus in Japanese Pet Cats,” Infection, Vol. 32, No. 1, 2004, pp. 57-58. doi:10.1007/s15010-004-3078-0
M. Kaba, H. Richet, I. Ravaux, J. Moreau, I. Poizot-Martin, A. Motte et al., “Hepatitis E Virus Infection in Patients Infected with the Human Immunodeficiency Virus,” Journal of Medical Virology, Vol. 83, No. 10, 2011, pp. 1704-1716. doi:10.1002/jmv.22177
M. S. Khuroo, V. K. Rustgi, G. J. Dawson, I. K. Mushahwar, G. N. Yattoo, S. Kamili et al., “Spectrum of Hepatitis E Virus Infection in India,” Journal of Medical Virology, Vol. 43, No. 3, 1994, pp. 281-286. doi:10.1002/jmv.1890430316
N. Kamar, J. Selves, J. Mansuy, L. Ouezzani, J. M. Péron, J. Guitard et al., “Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients,” New England Journal of Medicine, Vol. 358, No. 8, 2008, pp. 811-817. doi:10.1056/NEJMoa0706992
P. le Coutre, H. Meisel, J. Hofmann, C. Rocken, G. L. Vuong, S. Neuburger et al., “Reactivation of Hepatitis E Infection in a Patient with Acute Lymphoblastic Leukaemia after Allogeneic Stem Cell Transplantation,” Gut, Vol. 58, No. 5, 2009, pp. 699-702. doi:10.1136/gut.2008.165571
R. H. Purcell and S. U. Emerson, “Hepatitis E: An Emerging Awareness of an Old Disease,” Journal of Hepatology, Vol. 48, No. 3, 2008, pp. 494-503.
M. L. Mateos, C. Camarero, E. Lasa, J. L. Teruel, N. Mir and F. Baquero, “Hepatitis E Virus: Relevance in Blood Donors and Risk Groups,” Vox Sang, Vol. 76, No. 2, 1999, pp. 78-80. doi:10.1046/j.1423-0410.1999.7620078.x
N. F. Crum-Cianflone, J. Curry, J. Drobeniuc, A. Weintrob, M. Landrum, A. Ganesan et al., “Hepatitis E Virus Infection in HIV-Infected Persons,” Emerging Infectious Diseases, Vol. 18, No. 3, 2012, pp. 502-506. doi:10.3201/eid1803.111278
S. K. Stoszek, M. Abdel-Hamid, D. A. Saleh, S. El Kafrawy, S. Narooz, Y. Hawash et al., “High Prevalence of Hepatitis E Antibodies in Pregnant Egyptian Women. Transactions of Royal Society of Tropical Medicine and Hygiene, Vol. 100, No. 2, 2006, pp. 95-101. doi:10.1016/j.trstmh.2004.12.005
A. A. Adjei, Y. Tettey, J. T. Aviyase, C. Adu-Gyamfi, J. A. Mingle and E. T. Nartey, “Unexpected Elevated Alanine Aminotransferase, Asparte Aminotransferase Levels and Hepatitis E Virus Infection among Persons Who Work with Pigs in Accra, Ghana,” Virology Journal, Vol. 7, No. 7, 2010, pp. 336. http://www.virologyj.com/content/7/1/336
A. B. Labrique, K. Zaman, Z. Hossain, P. Saha, M. Yunus, A. Hossain et al., “Epidemiology and Risk Factors of Incident Hepatitis E Virus Infections in Rural Bangladesh,” American Journal Epidemiology, Vol. 172, No. 8, 2010, pp. 952-961. doi:10.1093/aje/kwq225
S. O. Ola, G. N. Odaibo, O. D. Olaleye and E. A. Ayoola, “Hepatitis B and E Viral Infections among Nigerian Healthcare Workers,” African Journal of Medicine and Medical Sciences, Vol. 41, No. 4, 2012, pp. 387-391.
P. Colson, C. Dhiver and R. Gerolami, “Hepatitis E Virus as a Newly Identified Cause of Acute Viral Hepatitis during Human Immunodeficiency Virus Infection,” Clinical Microbiology and Infection, Vol. 14, No. 12, 2008, pp. 1176-1180. doi:10.1111/j.1469-0691.2008.02102.x
M. H. Kuniholm, R. H. Purcell, G. M. McQuillan, R. E. Engle, A. Wasley and K. E. Nelson, “Epidemiology of Hepatitis E Virus in the United States: Results from the Third National Health and Nutrition Examination Survey, 1988-1994,” Journal of Infectious Diseases, Vol. 200, No. 1, 2009, pp. 48-56. doi:10.1086/599319
A. Kenfak-Foguena, F. Schoni-Affolter, P. Bürgisser, A. Witteck, K. E. A. Darling, H. Kovari et al., “Hepatitis E Virus Seroprevalence and Chronic Infections in Patients with HIV, Switzerland,” Emerging Infectious Diseases, Vol. 17, No. 6, 2011, pp. 1074-1078. doi:10.3201/eid1706.101067
P. Clemente-Casares, S. Pina, M. Buti, R. Jardi, M. Martín, S. Bofill-Mas and R. Girones, “Hepatitis E Virus Epidemiology in Industrialized Countries,” Emerging Infectious Diseases, Vol. 9, No. 4, 2003, pp. 448-454. doi:10.3201/eid0904.020351
WHO, “Guideline for Hand Hygiene in Health-Care Settings,” Morbidity and Mortality Weekly Report, Vol. 51, No. RR-16, 2002.
S. C. Robson, S. Adams, N. Brink, B. Woodruff and D. Bradley, “Hospital Outbreak of Hepatitis E,” Lancet, Vol. 339, No. 8806, 1992, pp. 1424-1425. doi:10.1016/0140-6736(92)91250-C
J. A. Curry, N. Adams and N. F. Crum-Cianflone, “Acute Hepatitis E Virus Infection in an HIV-Infected Person in the United States,” Annals of Internal Medicine, Vol. 150, No. 3, 2009, pp. 226-227. doi:10.7326/0003-4819-150-3-200902030-00028
F. Keane, M. Gompels, R. Bendall, R. Drayton, L. Jennings, J. Black et al., “Hepatitis E Virus Coinfection in Patients with HIV Infection,” HIV Medicine, Vol. 13, 2012, pp. 83-88.