Pineda Juan A, Cifuentes Celia, Parra Manuel, Merchante Nicolás, Pérez-Navarro Elisabet, Rivero-Juárez Antonio, Monje Patricia, Rivero Antonio, Macías Juan, Real Luis Miguel
aUnit of Infectious Disease and Clinical Microbiology, Hospital Universitario de Valmeand Instituto de Biomedicina de Sevilla (IBIS), Seville bUnit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
AIDS. 2014 Aug 24;28(13):1931-7. doi: 10.1097/QAD.0000000000000378.
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.
Prospective cohort study.
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.
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).
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.
了解西班牙艾滋病毒感染者中戊型肝炎病毒（HEV）感染的患病率、发病率及相关因素，并提供关于艾滋病毒/戊型肝炎病毒合并感染自然史的信息。
前瞻性队列研究。
对613例艾滋病毒感染患者在基线时及此后2年检测血清HEV IgG抗体。对阳性样本检测HEV-RNA。在血清学转换的患者中，分析基线和最终时间点之间采集样本的肝功能检查、血清HEV IgM抗体和HEV RNA的变化。
161例（26%）患者在基线时血清HEV IgG抗体检测呈阳性。HEV暴露在男性中比女性更常见（28%对18%；P = 0.022），且随年龄呈线性增加：40岁以下、40至49岁和50岁以上分别为16%、26%和44%（P = 0.000002）。1例患者在基线时血清中存在HEV-RNA。18例（4%）HEV血清学阴性患者在随访期间发生血清学转换。没有任何因素可预测血清学转换。1例血清学转换患者发生急性肝炎，4例出现无其他明显原因的轻度转氨酶升高。没有血清学转换病例发展为慢性HEV感染。在基线时HEV血清学阳性患者中，19%检测到血清学逆转。血清学逆转的患者比血清学仍为阳性的患者更常见CD4细胞计数低于500个/μl（77%对46%；P = 0.004）。
西班牙艾滋病毒感染患者中HEV暴露非常常见，且随年龄增加。发展为慢性感染极为罕见。大多数急性HEV感染病例在临床和生化方面似乎无表现，因此未被注意到。
