High risk of HEV infection among HIV-infected patients in Spain

OBJECTİVE The aim of this study is to investigate the prevalence of anti-HEV IgG in 448 HIV-infected patients and determine the role of age, gender and CD4 counts in the detection of anti-HEV IgG antibodies in blood.

MATERIAL AND METHODS Serum samples from 448 HIV-infected patients of Ramón y Cajal Hospital (Spain) were included. Age, gender and CD4 counts were assessed in all patients. Alanine aminotransferase levels (ALT) and clinical symptoms were recorded in all anti-HEV IgG positive individuals. Acute hepatitis E infection was defined when HEV-RNA and/or anti-HEV IgM was present. Anti-HEV IgG antibodies were detected in serum by a commercial enzyme immunoassay (EIA). All positive samples were further studied for the presence of anti-HEV IgM antibodies. Positive results by EIA were confirmed by Immunoblot assay.

HEV RNA was detected by RT- PCR in all anti-HEV IgG positive serum samples.

RESULTS 353/448 (78.7 %) of HIV patients were male. The median age was 46.3 (range 21-80). 31 patients (6.9%) had a CD4 count below 200 cells/mm3 (mean 542.9, range 3.15-1397). Anti-HEV IgG were detected in 10% (42/417, 95% C.I. 7.1 -13) of patients with >200 CD4 cell/mm3 and in 9.7% (3/31, 95% C.I. 0.9-20) of patients with <200 CD4 cells/mm3. No difference in seroprevalence between both groups was observed (p>0.01). According to gender, anti-HEV IgG were found in 35/353 (9.9%) males and 10/95 (10.5%) females. No difference in seroprevalence between these groups was observed (p>0.01). The overall prevalence of anti-HEV IgG was 10% (45/448, 95% C.I.7.2 -12.8). Anti-HEV IgM were detected in 3/45 anti-HEV IgG positive patients (7%) suggesting acute or recent infection, but HEV RNA was not present in these samples. 6/45 (13%) anti-HEV IgG positive patients had ALT levels twice above normal. Anti-HEV IgM or HEV RNA was not detected in these 6 individuals. HEV RNA was present only in 1/45 of anti-HEV IgG positive samples but the ALT value in this patient was not elevated. No patients presented clinical symptoms related to viral acute hepatitis.

CONCLUSİON The prevalence of anti-HEV IgG antibodies was 10.0 % in HIV-infected patients, a high seroprevalence completely different from that observed in other considered high risk groups. Therefore HIV-infected patients can be considered a risk group for HEV infection. There was no difference in seroprevalence according to age, gender and CD4 count. Asymptomatic HEV infections exist in HIV-infected individuals and chronic hepatitis E is a rare event in this high risk group.

Díez-Aguilar M, Galán JC, Gonzalez-Galdamez AL, Bordallo-Cardona M, Mateos Lindemann ML, Pérez Gracia MT.

GROUPS OF POPULATION Number of samples Prevalence

Blood donors 863 2.9%

Haemodialysis patients 63 6.3%

HCV post transfusionally infected children

42 0%

Sub Saharan immigrants 90 5.5%

Pregnant women 1040 3.6%

HIV infected patients (Madrid) 447 10%

HIV infected patients (Cataluña) 238 9%

Service of Microbiology, University Hospital Ramón y Cajal, Madrid, SPAIN

PREVALENCE OF ANTI-HEV IgG ANTIBODIES AMONG DIFFERENT GROUPS OF POPULATION IN SPAIN

Electronic picture of the hepatitis E virus

DATA TOTAL IgG Anti-HEV Positive Negative

Subjects N (%) 448 45 (10%) 403 (90%) Age (media+SD)

range 46.3

(21-74) 46.7

(27-57) 45.9

(21-80)

Males N (%) 351 (78.5%) 30 (8.5%) 321 (91.5%)

Females N (%) 97 (21.5%) 15 (15%) 82 (85%)

ALT (UI/L) (rango) 1663,09 (141-4148) 2063,75 (1426-2820) NA*

AST (UI/L) (rango) 1238,18 (45-4950) 1498 (387-2429) NA*

Bilirrubina (UI/L) (Rango)

7,71 (0,36-27,5) 11,25 (1,89-26) NA*

>200 CD4 cells/mm3 N (%)

417 (94.1%) 42/417 (10.01%) 375/417 (89.99 %)

<200 CD4 cells/mm3 N (%)

31 (5.9%) 3/31 (9.69%) 28/31 (90.33%)

IgM anti-VHE (%) 45 (10%) 3 (7%) 42 (4.4%)

ARN VHE (%) 45 (10%) 1 (22.2%) 44 (77.8%)

Coinfections HAV HBV HCV

2/45 (4.4%)

6/45 (13.3%) 7/45 (15.5%)

- -

POSTER: Nr. 2970

CHARACETERISTICS OF THE PATIENTS

REFERENCES

1. Kamar N, Garrouste C, Haagsma EB, Pischke S, Chauvet C, Dumortier J, Cannesson A, Cassuto-Viguier E, Thervet E, Conti F, Lebray P, Dalton HR, Santilla R, Kanaan N,

Essig M, Mousson C, Radenne S, Roque-Afonso AM, Izopet J, Rostaig L. Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have

recived solid organ transplants. Gastroenterology 2011;140:1481-89

2. González Tallón AI, Moreira Vicente V, Mateos Lindemann ML, Achécar Justo LM. Hepatitis crónica E en paciente inmunocompetente. Gastroenterol Hepatol. 2011;34

(6):398-400

3. Dalton HR, Bendall RP, KeaneFE, Tender RS, Ijaz S. persistent carriage of hepatiis E virus in patients with HIV infection. N Engl J Med 2009;361(10), 1025-1027

4. Kaba M, Brouqul P, Richet H. Chronic hepatitis E in human immunodeficiency virus-infected patients living in south eastern France. Program and Abstracts of the 19th

European Congress of Clinical Microbiology and Infectious Diseases. Helsinki. Finland(2009) (abstract P1996)

5. Maylin S, Stephan R, Molina JM, Peraldi MN, Scieux C, Nicand E, Simon F, Delaugerre C. Prevalence of antibodies and RNA genome of hepatitis E virus in a cohort of

French immunocompromised. J Clin Virol 2012;53:346-349

6. Keane FE, Gompels N, Bendall RP, Drayton R, Jennings L, Black J, Bargwanath G, Lin NX, Henley WE, Ngui SL, Ijaz S, Dalton HR. Hepatitis E virus coinfection in patients

with HIV infection. HIV Medicine 2012;13:83-88

7. Mateos-Lindemann ML, Gonzalez-Galdámez A, Bordallo-Carmona M, Pérez-Gracia MT. Are HIV-infected patients a high-risk population for hepatitis E virus infection in

Spain? Enferm Infecc Microbiol Clin 2012.doi:10.1016/j.eimc.2012.03.010

8. Mateos ML, Camarero C, Lasa E, Teruel JL,Mir N, Baquero F. Hepatitis E virus. Relevance in blood donors and risk groups. Vox Sang 1999;76:78-80

*NA: Not available