Hepatitis E virus immunological markers in HIV-infected individuals, Dominican Republic

Abstract

Hepatitis E virus (HEV) is an RNA (+) virus, primarily transmitted through foecal-contaminated water. HEV is endemic to various countries and currently considered the most common cause of viral hepatitis worldwide. In immunocompetent hosts causes a mild viral acute hepatitis, although in pregnant women it causes acute fulminant hepatitis. Recent studies have shown persistent infection by HEV in immunocompromised hosts, especially those infected by the HIV. The purpose of this investigation was to determine the presence of HEV specific antibodies in the Dominican Republic. Two cohorts were obtained from an outpatient clinic located in Santo Domingo, Dominican Republic; one consisted of 36 HIV (+) patients while the other was composed of 54 HIV (-) patients, both with persistent elevated liver enzymes and negative laboratory tests for hepatitis B or C. Informed consent was obtained from each participant. An epidemiological form was completed with relevant data of each participant; and their HIV status was confirmed by either rapid testing or record files. Blood samples where drawn from each participant to whom a rapid IgG test for HEV was performed, posteriorly a rapid IgM test for HEV was done to those who were positive to confirm chronic markers of HEV infection. Ten of the fourty-three (n=43) patients were positive for IgG against HEV. Of those 10, two were positive for HEV-IgM, both of which were on antiretroviral therapy and had a CD4 count over 200 cells/ml. Sixty percent of the patients who had a positive IgG against HEV had an ALT over 80 U/L, and an AST over 70 U/L. HEV should be considered as a differential diagnosis in HIV + patients with elevated liver enzymes in the Dominican Republic. Chronic infection with HEV should also be considered as an opportunistic infection in these patients in warm countries with poor water and sanitation quality.