HEV seroprevalence and associated risk factors among HIV-positive individuals in post-earthquake Kathmandu: a 2016 cross-sectional study

Abstract

Introduction: Hepatitis E virus (HEV) infection poses a significant public health challenge, particularly in immunocompromised populations such as those living with HIV. Limited data exist on HEV seroprevalence and its correlates among HIV-positive individuals in urban low-resource settings, especially in the aftermath of disasters. This study investigates HEV seroprevalence and risk factors among HIV positive individuals in 2016, a post-earthquake period in Kathmandu, Nepal, with relevance to ongoing challenges in 2025.

Methods: We conducted a cross-sectional serological study among 200 HIV-positive individuals from Sukraraj Tropical and Infectious Disease Hospital's (STIDH) Antiretroviral Therapy (ART) center in Kathmandu. Serological testing determined anti-HEV IgG and IgM status using Wantai Hepatitis E (HEV-IgG/M) ELISA kits. Sociodemographic, behavioral, and clinical data were collected via structured interviews and medical records. Multivariable logistic regression identified independent predictors of anti-HEV IgG seropositivity. Statistical analyses used Chi-square, Mann-Whitney U, and Cochran's Q tests, with p < 0.05 considered significant. A comparative general population sample (n = 100) from earthquake-affected districts was also analyzed.

Results: Overall, 43.5% (87/200) of HIV-positive participants tested positive for anti-HEV IgG. Key demographic predictors included increasing age, which showed a significant non-linear association (adjusted OR = 3.95 for age, 0.60 for age²; p < 0.001), and a marginal association with male gender (aOR = 2.03; p = 0.059). In contrast, no significant associations were observed between HEV seropositivity and specific drinking water sources, water processing methods, eating habits, smoking status, CD4 count, HIV viral load suppression, common comorbidities, or routine liver and hematological markers. anti-HEV IgG seroprevalence was considerably higher than that of Hepatitis B virus (4.5%) and Hepatitis C virus (5.0%) in the cohort and notably absent in a comparative general population sample. The predictive model showed good performance (AUC = 0.80), supporting its exploratory utility.

Conclusion: Our findings reveal a high burden of past HEV exposure among HIV-positive individuals in post-earthquake Kathmandu, with age being a key correlate. The absence of HEV IgG positivity in the general population sample suggests that HEV exposure during this period may have been localized to vulnerable clinical groups. The lack of association with traditional behavioral or clinical markers highlights the complexity of transmission in this setting. These results underscore the need to integrate HEV awareness and targeted screening into HIV care in endemic regions. Future studies should prioritize longitudinal follow-up, genotype surveillance, and environmental sampling to inform public health preparedness and response.

Keywords: HIV-positive; Hepatitis E virus (HEV); Kathmandu; Post-earthquake; Seroprevalence.

Fig. 1

Anti-HEV IgG seroprevalence by age group among HIV-positive participants

Fig. 2

Forest plot showing adjusted odds ratios (aORs) and 95% confidence intervals from a multivariable logistic regression model assessing predictors of anti-HEV IgG seropositivity

Fig. 3

Receiver Operating Characteristic (ROC) curve for the multivariable logistic regression model predicting anti-HEV IgG seropositivity