Objectives
The aim of the study was to assess the seroprevalence of hepatitis E virus (HEV) infection in an HIV‐infected population, as determined by HEV immunoglobulin G (IgG) antibodies (anti‐HEV).
Methods
The design of the study was cross‐sectional. Serum anti‐HEV IgG was determined by enzyme immunoassay in 238 HIV‐infected patients consecutively attending our out‐patient clinic between April and May 2011. In HEV‐seropositive patients, HEV RNA was analysed by nested reverse transcriptase–polymerase chain reaction (RT‐PCR). Associations between anti‐HEV and liver cirrhosis, route of HIV infection, hepatitis B virus (HBV) and hepatitis C virus (HCV) serological markers, age, sex and alanine aminotransferase (ALT) levels were examined by univariate and multivariate analysis.
Results
One hundred and forty patients (59%) had chronic liver disease (99% were HBV‐ and/or HCV‐coinfected). Liver cirrhosis was detected in 44 individuals (19%). Two hundred and twelve patients (89%) were on antiretroviral treatment; the median CD4 T‐cell count was 483 cells/μL [interquartile range (IQR) 313–662 cells/μL] and the HIV viral load was < 25 HIV‐1 RNA copies/mL. Overall, 22 patients (9%) were anti‐HEV positive. Liver cirrhosis was the only factor independently associated with the presence of anti‐HEV, which was documented in 23% of patients with cirrhosis and 6% of patients without cirrhosis (P = 0.002; odds ratio 5.77). HEV RNA was detected in three seropositive patients (14%), two of whom had liver cirrhosis.
Conclusions
Our findings show a high prevalence of anti‐HEV in HIV‐infected patients, strongly associated with liver cirrhosis. Chronic HEV infection was detected in a significant number of HEV‐seropositive patients. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection and to assess the role of chronic HEV infection in the pathogeneses of cirrhosis in this population.