Hepatitis E infection in Argentina, from immunocompetent to immunocompromised

DEBES J; MARTINEZ WASSAF M,; PISANO MB; MARIANELLI L; LOTTO M; COSSEANO H; BALDERRAMO D,; RÉ V

GORGIA, ATLANTA

Encuentro; 65th. Annual Meeting of the American Society of Tropical Medicine and Hygiene; 2016

American Society of Tropical Medicine and Hygiene

Background: Hepatitis E virus (HEV) is an RNA virus that can cause hepatitis in an epidemic fashion. In immunocompetent individuals, infection with HEV usually leads to silent seroconversion or to acute self-limited disease. In immunosuppressed individuals, HEV can develop into a chronic infection. Information about prevalence of HEV in immunocopromised subjects outside of Europe or North America is scarce. In this study we addressed the seroprevalence of HEV in immunocompetent and immunocompromised subjects in Argentina and associated risk factors. Methods: We performed third generation enzyme immunoassay for determination of IgG and IgM specific antibodies against HEV in 204 subjects infected with HIV, 81 subjects on hemodialysis (HD) and 58 solid-organ transplant recipients. HEV PCR was performed in all samples. 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 HIV-positive group we found 15 of 204 samples to be positive for HEV IgG (7.3%), compared to 19 of 433 samples (4.4%) in the control group. Interestingly, we found significantly lower CD4 counts on HEV-positive samples compared to HEV-negative samples (average CD4 count of 234 vs 422 mm3, p=0.01) indicating that patients with lower CD4 counts were more likely to be HEV IgG positive. Eight out of 81 subjects (9.8%) on HD and 5 of 58 (8.6%) of transplant recipients were positive for HEV IgG. Half of HEV seropositive patients in the HD group had positive IgM for HEV. There was no association between HEV serostatus and consumption of pork, alcohol, potable water or history of blood transfusion. There was a weak, but significant, association between fish consumption and HEV positivity. Only 1 sample showed a positive PCR for HEV, within the HIV group. Conclusions: Our study found an increased seroprevalence of HEV IgG in subjects infected with HIV, on HD and solid-organ transplant recipients in Argentina. However, the significant difference compared to controls was on HD and HIV-infected patients with low CD4 counts.