Acute and Chronic Hepatitis E Virus Infection in Human Immunodeficiency Virus-Infected U.S. Women

Abstract

Exposure to hepatitis E virus (HEV) is common in the United States, but there are few data on prevalence of HEV/human immunodeficiency virus (HIV) coinfection in U.S.

Populations: We tested 2,919 plasma samples collected from HIV-infected (HIV(+)) women and men enrolled in U.S. cohort studies for HEV viremia using a high-throughput nucleic acid testing (NAT) platform. NAT(+) samples were confirmed by real-time polymerase chain reaction. Samples were selected for testing primarily on the basis of biomarkers of liver disease and immune suppression. Prevalence of HEV viremia was 3 of 2,606 and 0 of 313 in tested plasma samples collected from HIV(+) women and men, respectively. All HEV isolates were genotype 3a. Based on follow-up testing of stored samples, 1 woman had chronic HEV infection for >4 years whereas 2 women had acute HEV detectable at only a single study visit.

Conclusions: To our knowledge, this is the first reported case of chronic HEV infection in an HIV(+) U.S. individual. We also confirm that chronic HEV infection can persist despite a CD4(+) count >200 cells/mm(3). Overall, though, these data suggest that HEV infection is rare in the HIV(+) U.S. population.

Figure 1

HEV study design. *TMA assay; **in-house real-time PCR

Figure 2

Panels A–C. Patterns of ALT, AST, CD4+ count, HEV viremia and antibodies over time through 2013 for three women with confirmed HEV viremia (Panels A–C). ALT and AST are in IU/L and CD4+ counts are cells/mm³. The ± symbol represents an inconclusive or borderline test result. ALT and AST measurements in WIHS were conducted on an annual basis (every other WIHS visit) from 1994–2001 and on a semi-annual basis (every WIHS visit) thereafter. CD4+ measurements in WIHS are conducted on a semi-annual basis (every WIHS visit).

Figure 2

Panels A–C. Patterns of ALT, AST, CD4+ count, HEV viremia and antibodies over time through 2013 for three women with confirmed HEV viremia (Panels A–C). ALT and AST are in IU/L and CD4+ counts are cells/mm³. The ± symbol represents an inconclusive or borderline test result. ALT and AST measurements in WIHS were conducted on an annual basis (every other WIHS visit) from 1994–2001 and on a semi-annual basis (every WIHS visit) thereafter. CD4+ measurements in WIHS are conducted on a semi-annual basis (every WIHS visit).

Figure 2

Panels A–C. Patterns of ALT, AST, CD4+ count, HEV viremia and antibodies over time through 2013 for three women with confirmed HEV viremia (Panels A–C). ALT and AST are in IU/L and CD4+ counts are cells/mm³. The ± symbol represents an inconclusive or borderline test result. ALT and AST measurements in WIHS were conducted on an annual basis (every other WIHS visit) from 1994–2001 and on a semi-annual basis (every WIHS visit) thereafter. CD4+ measurements in WIHS are conducted on a semi-annual basis (every WIHS visit).