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Prevalence and risk of hepatitis E virus infection in the HIV population of Nepal.

Prevalence and risk of hepatitis E virus infection in the HIV population of Nepal.
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Shrestha A, Adhikari A, Bhattarai M, Rauniyar R, Debes JD, Boonstra A, Lama TK, Al Mahtab M, Butt AS, Akbar SMF, Aryal N, Karn S, Manandhar KD, Gupta BP,


Shrestha A, Adhikari A, Bhattarai M, Rauniyar R, Debes JD, Boonstra A, Lama TK, Al Mahtab M, Butt AS, Akbar SMF, Aryal N, Karn S, Manandhar KD, Gupta BP, (click to view)

Shrestha A, Adhikari A, Bhattarai M, Rauniyar R, Debes JD, Boonstra A, Lama TK, Al Mahtab M, Butt AS, Akbar SMF, Aryal N, Karn S, Manandhar KD, Gupta BP,

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Virology journal 2017 11 2114(1) 228 doi 10.1186/s12985-017-0899-x

Abstract
BACKGROUND
Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal.

METHODS
We prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. All individuals were on antiretroviral therapy and healthy blood donors were used as controls.

RESULTS
We found a high prevalence of HEV IgG (39.4%) and HEV IgM (15.3%) in HIV-positive subjects when compared to healthy HIV-negative controls: 9.5% and 4.4%, respectively (OR: 6.17, 95% CI 4.42-8.61, p < 0.001 and OR: 3.7, 95% CI 2.35-5.92, p < 0.001, respectively). Individuals residing in the Kathmandu area showed a significantly higher HEV IgG seroprevalance compared to individuals residing outside of Kathmandu (76.8% vs 11.1%, OR: 30.33, 95% CI 18.02-51.04, p = 0.001). Mean CD4 counts, HIV viral load and presence of hepatitis B surface antigen correlated with higher HEV IgM rate, while presence of hepatitis C antibody correlated with higher rate of HEV IgG in serum. Overall, individuals with HEV IgM positivity had higher levels of alanine aminotransferase (ALT) than IgM negative subjects, suggesting active acute infection. However, no specific symptoms for hepatitis were identified. CONCLUSIONS
HIV-positive subjects living in Kathmandu are at higher risk of acquiring HEV infection as compared to the general population and to HIV-positive subjects living outside Kathmandu.

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