Hepatitis E infection in immunocompromised persons in Argentina

JOSE DEBES , ; MARIBEL MARTINEZ WASSAF ,; MARIA BELEN PISANO,; LEONARDO MARIANELLI,; MARTIN LOTTO; DOMINGO BALDERRAMO; HERNAN COSEANO; VIVIANA RÉ.

San Francisco, California

Congreso; The Liver Meeting 2015; 2015

American Association for the Study of Liver Diseases - http://www.aasld.org/events-professional-development/liver-meeting-

Background: Hepatitis E virus (HEV) is a single-stranded RNA virus that can cause hepatitis in anepidemic fashion. In immunocompetent individuals, infection with HEV usually leads to silent seroconversion or toacute self-limited disease. Several reports suggest an increased rate of seroprevalence of HEV in immunosuppressedindividuals, particularly those undergoing solid-organ transplantation. In this setting, HEV can develop into a chronicinfection. The data is less clear in patients infected with human immunodeficiency virus (HIV). Moreover, informationabout prevalence of HEV in immunocopromised subjects outside of Europe or North America is scarce. In this studywe addressed the seroprevalence of HEV in immunocompromised subjects in Argentina and associated risk factors.Methods: We performed third generation enzyme immunoassay for determination of IgG specific antibodies againstHEV in 95 subjects infected with HIV, 81 subjects on hemodialysis (HD) and 58 solid-organ transplant recipients. Onthose samples that were positive for HEV IgG, further assessment of HEV IgM levels. HEV PCR was performed in allsamples. Subjects on HD and transplant recipients were evaluated regarding social habits and potential risk factors.Results were compared to 433 HIV-negative, immunocompetent controls from our center. Results: In our entire HIVpositivegroup we found 8 of 95 samples to be positive for HEV IgG (8.8%), compared to 19 of 433 samples (4.4%) inthe control group. Interestingly, in a subgroup of patients (N27) with low CD4 counts 18% were positive for HEV IgG(p=0.03, compared to controls). This group had a much lower CD4 count when compared to the general HIV cohort(median CD4 count of 43/mm3 vs 543/mm3 respectively). Eight out of 81 subjects (9.8%) on HD and 5 of 58 (8.6%) oftransplant recipients were positive for HEV IgG. Interestingly, half of HEV seropositive patients in the HD group hadpositive IgM for HEV. There was no association between HEV serostatus and consumption of pork, fish, potable wateror history of blood transfusion. Only 1 sample showed a positive PCR for HEV, within the HIV group. This patient hadrecent history of vomiting and diarrhea and likely experienced acute HEV infection.Conclusions: Our study found an increased seroprevalence of HEV IgG in subjects infected with HIV, on HD andsolid-organ transplant recipients in Argentina. However, the only significant difference compared to controls was onHIV-infected patients with low CD4 counts.