title: Cirrhosis, liver transplantation and HIV infection are risk factors associated with hepatitis E virus infection.
abstract: BACKGROUND
  Acute and chronic hepatitis E have been associated with high mortality and development of cirrhosis, particularly in solid-organ recipients and patients infected by human immunodeficiency virus. However, data regarding the epidemiology of hepatitis E in special populations is still limited.
  
  
  OBJECTIVE
  Investigate seroprevalence and possible factors associated with HEV infection in a large cohort of immunosuppressed patients.
  
  
  METHODS
  Cross-sectional study testing IgG anti-HEV in serum samples from 1373 consecutive individuals: 332 liver-transplant, 296 kidney-transplant, 6 dual organ recipients, 301 non-transplanted patients with chronic liver disease, 238 HIV-infected patients and 200 healthy controls.
  
  
  RESULTS
  IgG anti-HEV was detected in 3.5% controls, 3.7% kidney recipients, 7.4% liver transplant without cirrhosis and 32.1% patients who developed post-transplant cirrhosis (p<0.01). In patients with chronic liver disease, IgG anti-HEV was also statistically higher in those with liver cirrhosis (2% vs 17.5%, p<0.01). HIV-infected patients showed an IgG anti-HEV rate of 9.2%, higher than those patients without HIV infection (p<0.03). Multivariate analysis showed that the factors independently associated with anti-HEV detection were liver cirrhosis, liver transplantation and HIV infection (OR: 7.6, 3.1 and 2.4). HCV infection was a protective factor for HEV infection (OR: 0.4).
  
  
  CONCLUSIONS
  HEV seroprevalence was high in liver transplant recipients, particularly those with liver cirrhosis. The difference in anti-HEV prevalence between Liver and Kidney transplanted cases suggests an association with advanced liver disease. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection or whether HEV infection may play a role in the pathogeneses of cirrhosis.
authors: Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Mar
authors: M
authors: Riveiro-Barciela
authors: Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: María
authors: M
authors: Buti
authors: Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: María
authors: M
authors: Homs
authors: Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Isabel
authors: I
authors: Campos-Varela
authors: Nephrology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Carmen
authors: C
authors: Cantarell
authors: Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Manuel
authors: M
authors: Crespo
authors: Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Lluís
authors: L
authors: Castells
authors: Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: David
authors: D
authors: Tabernero
authors: Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Josep
authors: J
authors: Quer
authors: Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Rafael
authors: R
authors: Esteban
authors: Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Universitario Vall d'Hebron, Barcelona, Spain; Liver Pathology Unit/Virology Unit Biochemistry and Microbiology Departments, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Francisco
authors: F
authors: Rodriguez-Frías
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006508:Hepatitis Antibodies / Q000097:blood / Q000276:immunology; D016751:Hepatitis E / Q000453:epidemiology* / Q000209:etiology*; D016752:Hepatitis E virus / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D008103:Liver Cirrhosis / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D006508:Hepatitis Antibodies; D007074:Immunoglobulin G