Liver Foundation Nepal, Kathmandu, Nepal.
Kathmandu Research Institute for Biological Sciences, Lalitpur, Nepal.
Virol J. 2017 Nov 21;14(1):228. doi: 10.1186/s12985-017-0899-x.
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.
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.
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.
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.
在免疫功能正常的宿主中，戊型肝炎病毒（HEV）感染可导致地方性流行地区的急性肝炎，在非地方性流行地区免疫功能低下的宿主中可导致慢性感染。大多数评估 HIV 感染者中 HEV 感染的研究都是在发达国家进行的，这些国家通常受 HEV 基因型 3 的影响。本研究的目的是测量尼泊尔 HIV 感染者中 HEV 的流行率和获得风险。
我们前瞻性评估了来自尼泊尔的 459 名 HIV 阳性个体（HEV 的地方性流行国家）的 HEV 血清流行率，并评估了与 HEV 感染相关的危险因素。所有个体均接受抗逆转录病毒治疗，健康的 HIV 阴性献血者作为对照。
与健康的 HIV 阴性对照组相比，我们发现 HIV 阳性个体的 HEV IgG（39.4%）和 HEV IgM（15.3%）的阳性率较高：分别为 9.5%和 4.4%（OR：6.17，95%CI 4.42-8.61，p<0.001 和 OR：3.7，95%CI 2.35-5.92，p<0.001）。居住在加德满都地区的个体与居住在加德满都以外地区的个体相比，HEV IgG 血清阳性率明显更高（76.8%比 11.1%，OR：30.33，95%CI 18.02-51.04，p=0.001）。平均 CD4 计数、HIV 病毒载量和乙型肝炎表面抗原的存在与 HEV IgM 率升高相关，而丙型肝炎抗体的存在与血清中 HEV IgG 率升高相关。总体而言，HEV IgM 阳性个体的丙氨酸氨基转移酶（ALT）水平高于 IgM 阴性个体，提示急性感染活跃。然而，没有确定特定的肝炎症状。
与一般人群和居住在加德满都以外的 HIV 阳性个体相比，居住在加德满都的 HIV 阳性个体感染 HEV 的风险更高。
