title: HIV, HEV and cirrhosis: evidence of a possible link from eastern Spain.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Biochemistry, Vall d'Hebron Hospital, University "Autonoma" of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Jardi
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.forename: M
authors.initials: M
authors.lastname: Homs
authors.forename: E
authors.initials: E
authors.lastname: van den Eynde
authors.forename: R
authors.initials: R
authors.lastname: Girones
authors.forename: J
authors.initials: J
authors.lastname: Rodriguez-Manzano
authors.forename: A
authors.initials: A
authors.lastname: Caballero
authors.forename: M
authors.initials: M
authors.lastname: Buti
authors.forename: R
authors.initials: R
authors.lastname: Esteban
authors.forename: F
authors.initials: F
authors.lastname: Rodriguez-Frias
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood*; D018791:CD4 Lymphocyte Count; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D016751:Hepatitis E / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D016752:Hepatitis E virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000235:genetics / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013030:Spain / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D012367:RNA, Viral