Hepatitis E virus infection in HIV-positive patients in Hong Kong

Abstract

(Laymen’s) Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in human emerging nowadays. Although it does not cause severe and threatening infection, it is a potential virus that can lead to chronic infection in immunocompromised patients. The percentage of HEV infection is found to be higher in immunocompromised patients. Also, HEV infection in immunocompromised patients was found to be more severe and could lead to cirrhosis. The data of HEV infection in immunocompromised patients were discovered in many Western countries, while data of HEV infection in immunocompromised patients in Hong Kong is lacking. This study is to study the seroprevalence, molecular prevalence and genotype of HEV in HIV patients. Seroprevalence of HEV in HIV patients was discovered to be slightly higher than that of the healthy population, while the HEV-RNA was detected in 2.17% of HIV patients. The HEV dominant group identified in this study was genotype 3 (80%) of the RNA-positive patients. However, the dominant group (genotype 4) circulating via foodborne route in Hong Kong is different to the finding in this study. Therefore, the source and transmission route of these HEV in these specific population (i.e. HIV patient) is not known and warrant further investigation. The clinical practise on handling HIV patients would need to be changed. For example, HEV screening test to be performed in these patients, and once positive, they should receive treatment promptly.

(Scientific) Hepatitis E virus (HEV) infection is an emerging acute infection, which is usually acute and self-limiting in healthy population. Immunocompromised patients are at risk of progressing to chronic HEV infection, resulting in severe liver damage and cirrhosis. Seroprevalence of HEV infection of immunocompromised patients were discovered to be higher than that of healthy population. Most of the studies were from the Western countries and the data of HEV infection in immunocompromised patients is lacking in Hong Kong. Therefore, this study was to determine the seroprevalence, molecular prevalence and genotype of HEV infection in HIV-positive patients. Thousand and thirteen HIV-positive patients’ plasma samples were provided by 2 local hospitals. Seroprevalence of HIV-positive patients (24.67%) were identified to be slightly higher than that of the healthy population (20.7%), while HEV-RNA-positive samples were discovered to be 2.17% among the HIV-positive patients. The ratio of HEV genotype 3 and HEV genotype 4 within the RNA-positive patients was 9:2 and genotype 3 was identified to be the dominated group in this study. In Hong Kong, HEV genotype 4 was circulating around the population in foodborne transmission. The source and the transmission route are not known for these patients and further studies on these aspects are highly warranted. This study is to increase the awareness of HEV infection in HIV-positive patients and to improve the clinical practise on the management of HIV patients.