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Higher Risk of Chronic Hepatitis E Virus infection in Patients with Human Immunodeficiency Virus-1: An Iranian Cross- sectional Study

Document Type : Original Research

Authors

1 Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Microbiology, Shahid Sadoghi University of Medical Science, Yazd, Iran

3 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

4 Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran

5 Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran

6 Department of Medical Microbiology, Kerman University of Medical Sciences, Kerman, Iran

7 Behavioral Disease Counseling Center, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background & Objective: Hepatitis E Virus (HEV) infection may be common in Human Immunodeficiency Virus (HIV-1) patients and may lead to chronic infection as well as cirrhosis. We intended to determine the incidence of HEV infection among HIV-1 patients in comparison to individuals without HIV-1 infection.
Methods: In our cross-sectional study, 87 HIV-1-positive patients were compared to 93 healthy individuals in Kerman, Iran. Plasma and peripheral blood mononuclear cells (PBMCs) were obtained from all participants. Plasmas were evaluated for HEV IgM and IgG using the ELISA kit. Then, reverse transcriptase-nested polymerase chain reaction (RT-nested PCR) was used in RNA extractions from PBMCs to check for the presence of HEV RNA.
Results: Among the subjects examined in our study, 61 (70.1%) and 71 (77.4%) out of patients with HIV-1 infection and healthy individuals were male, respectively. The average ages of patients with HIV-1 and the control group were 40.2 years and 39.9 years, respectively. No discernible differences existed between the two groups based on IgM and IgG seropositivity against the HEV. However, HEV-RNA was found in 8% of patients with HIV-1 and 1.1% of HIV-1-negative individuals (P=0.03). There was also an association between the HEV genome and anti-HEV and anti-HCV antibodies in HIV-1-positive patients (P=0.02 and P=0.014, respectively).
Conclusion: HEV infection was more common in HIV-1 patients and may develop a chronic infection in immunocompromised individuals. Here, we suggest molecular-based HEV diagnostic tests, including RT-PCR assays, should be performed in HIV-1 patients with unknown impaired liver function tests.

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References
  1. Khuroo MS KM, Khuroo NS. Hepatitis E: Discovery, global impact, control and cure. World J Gastroenterol. 2016 Aug 21;22(31). [DOI:10.3748/wjg.v22.i31.7030] [PMID] [PMCID]
  2. Pauli G, Aepfelbacher M, Bauerfeind U, Blumel J, Burger R, Gartner B, et al. Hepatitis E Virus. Transfus Med Hemother. 2015;42(4):247-65. [DOI:10.1159/000431191] [PMID] [PMCID]
  3. Hofmeister MG, Foster MA, Teshale EH. Epidemiology and Transmission of Hepatitis A Virus and Hepatitis E Virus Infections in the United States. Cold Spring Harb Perspect Med. 2019;9(4):a033431. [DOI:10.1101/cshperspect.a033431] [PMID] [PMCID]
  4. Rivero-Juarez A, Lopez-Lopez P, Frias M, Rivero A. Hepatitis E Infection in HIV-Infected Patients. Front Microbiol. 2019;10:1425. [DOI:10.3389/fmicb.2019.01425] [PMID] [PMCID]
  5. Aggarwal R. Diagnosis of hepatitis E. Nat Rev Gastroenterol Hepatol. 2013;10(1):24-33. [DOI:10.1038/nrgastro.2012.187] [PMID]
  6. Taniguchi M, Kim SR, Mishiro S, Takahashi K, Shin MH, Yun H, et al. Epidemiology of hepatitis E in Northeastern China, South Korea and Japan. J Infect. 2009;58(3):232-7. [DOI:10.1016/j.jinf.2009.01.011] [PMID]
  7. Antony J, Celine T. A Hospital-based Retrospective Study on Frequency and Distribution of Viral Hepatitis. J Glob Infect Dis. 2014;6(3):99-104. [DOI:10.4103/0974-777X.138499] [PMID] [PMCID]
  8. Sharifipour S, Rad KD. Seroprevalence of hepatitis E virus among different age groups in Tehran, Iran. New Microbes and New Infections. 2020;34:100638. [DOI:10.1016/j.nmni.2019.100638] [PMID] [PMCID]
  9. Behzadifar M, Lankarani KB, Abdi S, Taheri Mirghaed M, Beyranvand G, Keshavarzi A, et al. Seroprevalence of Hepatitis E Virus in Iran: A Systematic Review and Meta-analysis. Middle East J Dig Dis. 2016;8(3):189-200. [DOI:10.15171/mejdd.2016.31] [PMID] [PMCID]
  10. Kamar N, Selves J, Mansuy JM, Ouezzani L, Peron JM, Guitard J, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med. 2008;358(8):811-7. [DOI:10.1056/NEJMoa0706992] [PMID]
  11. Colson P, Kaba M, Moreau J, Brouqui P. Hepatitis E in an HIV-infected patient. J Clin Virol. 2009;45(4):269-71. [DOI:10.1016/j.jcv.2009.06.002] [PMID]
  12. Dalton HR, Bendall RP, Keane FE, Tedder RS, Ijaz S. Persistent carriage of hepatitis E virus in patients with HIV infection. N Engl J Med. 2009;361(10):1025-7. [DOI:10.1056/NEJMc0903778] [PMID]
  13. Dalton HR, Fellows HJ, Stableforth W, Joseph M, Thurairajah PH, Warshow U, et al. The role of hepatitis E virus testing in drug-induced liver injury. Aliment Pharmacol Ther. 2007;26(10):1429-35. [DOI:10.1111/j.1365-2036.2007.03504.x] [PMID]
  14. Scotto G, Grisorio B, Filippini P, Ferrara S, Massa S, Bulla F, et al. Hepatitis E virus co-infection in HIV-infected patients in Foggia and Naples in southern Italy. Infect Dis (Lond). 2015;47(10):707-13. [DOI:10.3109/23744235.2015.1049658] [PMID]
  15. Lopez-Lopez P, Frias M, Camacho A, Rivero A, Rivero-Juarez A. Human immunodeficiency virus infected patients are not at higher risk for hepatitis e virus infection: A systematic review and meta-analysis. Microorganisms. 2019;7(12):618. [DOI:10.3390/microorganisms7120618] [PMID] [PMCID]
  16. Vazquez-Moron S, Berenguer J, Gonzalez-Garcia J, Jimenez-Sousa MA, Canorea I, Guardiola JM, et al. Prevalence of hepatitis E infection in HIV/HCV-coinfected patients in Spain (2012-2014). Sci Rep. 2019;9(1):1143. [DOI:10.1038/s41598-018-37328-6] [PMID] [PMCID]
  17. Sellier P, Mazeron MC, Tesse S, Badsi E, Evans J, Magnier JD, et al. Hepatitis E virus infection in HIV-infected patients with elevated serum transaminases levels. Virol J. 2011;8(1):171. [DOI:10.1186/1743-422X-8-171] [PMID] [PMCID]
  18. Dalton HR, Keane FE, Bendall R, Mathew J, Ijaz S. Treatment of chronic hepatitis E in a patient with HIV infection. Ann Intern Med. 2011;155(7):479-80. [DOI:10.7326/0003-4819-155-7-201110040-00017] [PMID]
  19. Caballero OL, Menezes CL, Costa MC, Fernandes SC, Anacleto TM, de Oliveira RM, et al. Highly sensitive single-step PCR protocol for diagnosis and monitoring of human cytomegalovirus infection in renal transplant recipients. J Clin Microbiol. 1997;35(12):3192-7. [DOI:10.1128/jcm.35.12.3192-3197.1997] [PMID] [PMCID]
  20. Dalvand N, Dalvand A, Sharifi Z, Hosseini SM. Prevalence of hepatitis E virus in thalassemia patients with hepatitis C in Tehran, Iran. Iran J Microbiol. 2019;11(6):535-40. [DOI:10.18502/ijm.v11i6.2226]
  21. Curry JA, Adams N, Crum-Cianflone NF. Acute hepatitis E virus infection in an HIV-infected person in the United States. Ann Intern Med. 2009;150(3):226-7. [DOI:10.7326/0003-4819-150-3-200902030-00028] [PMID] [PMCID]
  22. Harritshoj LH, Hother CE, Sengelov H, Daugaard G, Sorensen SS, Jacobsen S, et al. Epidemiology of hepatitis E virus infection in a cohort of 4023 immunocompromised patients. Int J Infect Dis. 2020;91:188-95. [DOI:10.1016/j.ijid.2019.11.014] [PMID]
  23. Rivero-Juarez A, Lopez-Lopez P, Frias M, Rivero A. Hepatitis E infection in HIV-infected patients. Frontiers in microbiology. 2019;10:1425. [DOI:10.3389/fmicb.2019.01425] [PMID] [PMCID]
  24. Joulaei H, Rudgari O, Motazedian N, Gorji-Makhsous S. Hepatitis E virus seroprevalence in HIV positive individuals in Shiraz, Southern Iran. Iran J Microbiol. 2015;7(2):103-8.
  25. Mateos‐Lindemann ML, Diez‐Aguilar M, Galdamez ALG, Galán JC, Moreno A, Pérez‐Gracia MT. Patients infected with HIV are at high‐risk for hepatitis E virus infection in Spain. J Med Virol. 2014;86(1):71-4. [DOI:10.1002/jmv.23804] [PMID]
  26. Salvio AL, Lopes AO, Almeida AJ, Gardinali NR, Lima LRP, de Oliveira JM, et al. Detection and quantification of hepatitis E virus in the absence of IgG and IgM anti-HEV in HIV-positive patients. J Appl Microbiol. 2018;125(4):1208-15. [DOI:10.1111/jam.14024] [PMID]
  27. Ollier L, Tieulie N, Sanderson F, Heudier P, Giordanengo V, Fuzibet JG, et al. Chronic hepatitis after hepatitis E virus infection in a patient with non-Hodgkin lymphoma taking rituximab. Ann Intern Med. 2009;150(6):430-1. [DOI:10.7326/0003-4819-150-6-200903170-00026] [PMID]
  28. Lopez-Fabal MF, Gomez-Garces JL. [Seroprevalence of hepatitis E virus in patients with hepatitis C and / or infected with HIV]. Rev Esp Quimioter. 2015;28(6):314-6.
  29. de Moraes ACP, Gouvea MG, Ferreira AC, Pinho JRR, de Mello ES, D'Albuquerque LAC, et al. The impact of hepatitis E infection on hepatic fibrosis in liver transplanted patients for hepatitis C infection. Braz J Infect Dis. 2021;25(3):101587. [DOI:10.1016/j.bjid.2021.101587] [PMID] [PMCID]
  30. Kaba M, Richet H, Ravaux I, Moreau J, Poizot-Martin I, Motte A, et al. Hepatitis E virus infection in patients infected with the human immunodeficiency virus. J Med Virol. 2011;83(10):1704-16. [DOI:10.1002/jmv.22177] [PMID]
  31. Ramezani A, Mohraz M, Banifazl M, Aghakhani A. Significance of hepatitis E virus infection in HIV-infected patients: a challenging issue. Asian Pac J trop Med. 2015;5(5):337-41. [DOI:10.1016/S2222-1808(14)60794-5]
  32. Shadmand E, Baharlou R, Shokouh MR, Mousavi Nasab SD, Ahmadi Vasmehjani A, Sadeghi K, et al. Sero-epidemiology of hepatitis E and D infections among HIV-infected and HIV/HCV-coinfected patients in Jahrom, Southern Iran. Arch Clin Infect Dis. 2018;13(2). [DOI:10.5812/archcid.77069]
  33. Shrestha A, Adhikari A, Bhattarai M, Rauniyar R, Debes JD, Boonstra A, et al. Prevalence and risk of hepatitis E virus infection in the HIV population of Nepal. Virol J. 2017;14(1):228. [DOI:10.1186/s12985-017-0899-x] [PMID] [PMCID]
  34. Maylin S, Stephan R, Molina JM, Peraldi MN, Scieux C, Nicand E, et al. Prevalence of antibodies and RNA genome of hepatitis E virus in a cohort of French immunocompromised. J Clin Virol. 2012;53(4):346-9. [DOI:10.1016/j.jcv.2012.01.001] [PMID]
  35. Kenfak-Foguena A, Schoni-Affolter F, Burgisser P, Witteck A, Darling KE, Kovari H, et al. Hepatitis E Virus seroprevalence and chronic infections in patients with HIV, Switzerland. Emerg Infect Dis. 2011;17(6):1074-8. [DOI:10.3201/eid/1706.101067] [PMID] [PMCID]
  36. Madejon A, Vispo E, Bottecchia M, Sanchez-Carrillo M, Garcia-Samaniego J, Soriano V. Lack of hepatitis E virus infection in HIV patients with advanced immunodeficiency or idiopathic liver enzyme elevations. J Viral Hepat. 2009;16(12):895-6. [DOI:10.1111/j.1365-2893.2009.01138.x] [PMID]
  37. Ramezani A, Velayati AA, Khorami-Sarvestani S, Eslamifar A, Mohraz M, Banifazl M, et al. Hepatitis E virus infection in patients infected with human immunodeficiency virus in an endemic area in Iran. Int J STD AIDS. 2013;24(10):769-74. [DOI:10.1177/0956462413484457] [PMID]

Iranian Journal of Pathology
Volume 18, Issue 2
April 2023
Pages 125-133
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History
  • Receive Date: 10 April 2022
  • Revise Date: 17 September 2022
  • Accept Date: 28 February 2022
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