Assessment of hepatitis E seropositivity among HIV-infected patients in Bulgaria

Abstract

It is debatable whether HIV-infected patients are at greater risk for hepatitis E virus (HEV) infection compared with healthy subjects. The reported anti-HEV seroprevalence among different groups in Bulgaria varied from 9.04% to 25.9%, but the information regarding the HIV population is still missing. The aim of the present study was to evaluate hepatitis E seroprevalence among HIV-infected patients in Bulgaria and to analyze demographic and immunological factors associated with HEV infection. Serum samples of 312 HIV-infected patients were analyzed retrospectively. Age, sex, residence and laboratory markers for HEV, HBV, HCV and HIV infection, and lymphocytes subpopulations were collected for all patients. None of the tested samples were positive for HEV RNA. HEV seroprevalence among HIV-infected patients was 10.9%. Males were more affected with the highest prevalence of positivity in the age group > 30 to ≤ 40 years. The documented HIV transmission routes in HIV/HEV co-infected group were heterosexual, homosexual, intravenous drug use (IDU), and vertical with predominace of the heterosexual route (z = 0.2; p = 0.804). There was a statistically significant trend of HIV mixed infection with routes of HIV transmission other than homosexual - heterosexual in HIV/HEV group and injection drug use in HIV/HBV/HCV co-infected group. The route of HIV transmission, in contexts of patients' behavior, was associated with HEV prevalence among HIV-infected patients.

Keywords: HEV seropositivity; HIV infection; HIV/HEV co-infection; Hepatitis E virus.

Fig. 1

Flow diagram of the study and the differentiation of evaluated groups. HIV = human immunodeficiency virus; HBV = hepatitis B virus; HCV = hepatitis C virus; IgM = immunoglobulin M; IgG = immunoglobulin G; HIV mono = HIV mono-infected; HIV/HBV/HCV = HIV positive for HBV and/or HCV, but HEV negative; HIV/HEV = HIV positive for HEV. Legend: ^a The number is for anti-HEV IgM positive only or for anti-HEV IgG positive; ^b The number is for HIV/HBV co-infected or HIV/HCV co-infected.

Fig. 2

Distribution of HIV evaluated patients and HIV/HEV co-infected patients according to different administrative districts of Bulgaria. Legend: Values on the map represents the number of HIV infected by region, followed by the HIV/HEV patients, placed in brackets (if any).

Fig. 3

Prevalence [%] of different CD subpopulations within HIV-mono, HIV/HBV/HCV and HIV/HEV cohortsLegend: P-values were calculated by chi-square test or Fisher's exact test as required.