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Abstract Details
Hepatitis E Infection in a Longitudinal Cohort of HCV and HCV/HIV Coinfected Persons
AIDS Res Hum Retroviruses. 2021 Apr 1. doi: 10.1089/AID.2020.0303. Online ahead of print.
Kenneth E Sherman12, Shyam Kottilil3, Susan D Rouster4, Enass A Abdel-Hameed5, Ceejay L Boyce6, Heidi L Meeds7, Norah Terrault8, M Tarek Shata9
Author information
1University of Cincinnati College of Medicine, 12303, Internal Medicine Digestive Diseases, College of Medicine Digestive Diseases, 231 Albert Sabin Way, Cincinnati, Ohio, United States, 45267.
2University of Cincinnati; kenneth.sherman@uc.edu.
3University of Maryland Baltimore, 12265, Institute of Human Virology, Baltimore, Maryland, United States; SKottilil@ihv.umaryland.edu.
4University of Cincinnati College of Medicine, 12303, Internal Medicine Digestive Diseases, Cincinnati, Ohio, United States; susan.rouster@uc.edu.
5University of Cincinnati College of Medicine, 12303, Internal Medicine Digestive Diseases, Cincinnati, Ohio, United States; abdelhes@ucmail.uc.edu.
6University of Cincinnati College of Medicine, 12303, Internal Medicine Digestive Diseases, Cincinnati, Ohio, United States; boycecl@uw.edu.
7University of Cincinnati College of Medicine, 12303, Internal Medicine Digestive Diseases, Cincinnati, Ohio, United States; Heidi.meeds@uc.edu.
8University of Southern California Keck School of Medicine, 12223, Division of GI and Liver, Los Angeles, California, United States; terrault@usc.edu.
9University of Cincinnati College of Medicine, 12303, Internal Medicine Digestive Diseases, Cincinnati, Ohio, United States; shatamt@UCMAIL.UC.EDU.
Abstract
Background Hepatitis E virus (HEV) is thought to be common in the United States with increased prevalence in those with concomitant hepatitis C (HCV) or HCV/HIV coinfection. Little is known regarding true prevalence, incidence, and antibody seroreversion in these populations. We sought to define these rates among HCV and HCV/HIV coinfected persons in the Washington, DC area. Methods Two longitudinal cohorts of HCV and HCV/HIV coinfected subjects from the Washington, DC area were evaluated. Multiple HEV test modalities were deployed including IgG and IgM antibody testing, evaluation of antibody avidity, HEV RNA testing, and HEV ELISPOT analysis. Results 379 individuals were evaluated including 196 who were HCV monoinfected and 183 HCV/HIV coinfected. Anti-HEV IgG was detected and confirmed in 18.7% of the cohort at baseline. None demonstrated anti-HEV IgM positive or HEV RNA positive results. Proportions of HEV antibody prevalence did not significantly differ between groups. Longitudinal follow-up samples were available for 226 individuals with a mean follow-up time of 24 months. Seroreversion was noted in 1.8%. One HCV/HIV infected person seroconverted to HEV IgG positivity in the followed cohort. 40% of the positive population demonstrated high avidity suggestive of more remote exposure. Interferon gamma ELISPOT was performed in 70 subjects and false negative and false positive HEV ELISA antibodies were identified. Conclusions In HIV-infected persons in the U.S. HEV exposure and seroconversion, is frequent enough that HEV should be considered in the differential diagnosis of acute hepatitis. Seroreversion may lead to underestimation of true infection risk.