Seroepidemiology of hepatitis E virus infection in an urban population in Zambia: strong association with HIV and environmental enteropathy.
BACKGROUND
Hepatitis E virus (HEV) infection causes major epidemics of infectious hepatitis, with high mortality rates in pregnant women. Recent reports indicate that HEV coinfections with human immunodeficiency virus (HIV) may have a more protracted course. However, the impact of HEV infections in communities heavily affected by HIV remains poorly studied. We set out to examine age-related seroprevalence in a community where we have previously carried out studies on environmental enteropathy.


METHODS
Blood samples from 194 children and 106 adults were examined for immunoglobulin G and immunoglobulin M antibodies for HEV. HEV data were correlated with HIV status and morphometric analysis of small intestinal biopsies.


RESULTS
Seroprevalence rose throughout childhood, from 8% in children aged 1-4 years, to 36% in children aged 10-14 years. In adults, the overall prevalence was 42%, with 28% in HIV-seronegative adults and 71% in HIV-seropositive adults (odds ratio, 6.2; 95% confidence interval, 2.2-18; P = .0001). In adults, villous height and crypt depth measurements showed that HEV seropositivity was associated with worse enteropathy (P = .05 and P = .005, respectively).


CONCLUSIONS
HEV infection is common in Zambia. In adults it is strongly associated with HIV status, and also with environmental enteropathy.
Tropical Gastroenterology and Nutrition Group, UNZA School of Medicine, Lusaka, Zambia.
Choolwe
C
Jacobs
Clarance
C
Chiluba
Cynthia
C
Phiri
Mpala Mwanza
MM
Lisulo
Mumba
M
Chomba
Philip C
PC
Hill
Samreen
S
Ijaz
Paul
P
Kelly
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000097:blood / Q000821:virology; D005260:Female; D019053:HIV Enteropathy / Q000097:blood / Q000821:virology*; D015658:HIV Infections / Q000097:blood / Q000821:virology*; D006508:Hepatitis Antibodies / Q000097:blood; D016751:Hepatitis E / Q000097:blood / Q000453:epidemiology* / Q000821:virology*; D016752:Hepatitis E virus; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D008297:Male; D016036:Seroepidemiologic Studies; D014505:Urban Population; D015024:Zambia / Q000453:epidemiology
D006508:Hepatitis Antibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M
HIV infection; environmental enteropathy; epidemiology; hepatitis E virus; seroprevalence