Conclusions
HEV infection accounted for 4% of acute liver abnormalities among HIV-infected persons. Overall, HEV was detected in 6% of HIV-infected participants, similar to the 5%–21% reported earlier from the United States. Because study participation was limited to persons who had a sample available for HEV testing near the time of ALT increase, we might have missed cases of HEV infection. Overall, on the basis of our study and data from other industrialized countries, HEV is a cause of liver abnormalities in HIV-infected persons but does not seem to be more common in this population than in the general population.
HEV seropositivity did not increase over the course of the HIV epidemic. Despite increasing reports of HEV among HIV-infected persons and the general population, this increase is probably associated with increased recognition and testing. Recent studies in the United States and Europe have shown that HEV seroprevalence is stable or decreasing.
HEV infections among HIV-infected persons have been reported; however, whether this population is at increased risk for HEV infection remains uncertain. Recent studies from Europe suggest that HIV-infected persons or other immunocompromised persons are not at increased risk of acquiring HEV infections. Nonetheless, these groups are at higher risk for chronic HEV infection.
We propose that a diagnosis of HEV infection be considered for persons with viral-like hepatitis. Serologic test results may be negative despite ongoing HEV infection; hence, for HIV-infected persons (especially those with low CD4 cell counts), PCR testing for HEV RNA should be conducted. Because HEV infection may be fulminant in the presence of underlying liver disease (common among HIV-infected persons) and may lead to chronic infection in immunosuppressed persons, testing should be considered for these persons as treatment options for HEV infection evolve. Moreover, chronic HEV infection may be averted by reducing the level of immunosuppression and use of highly active antiretroviral therapy, but more data are needed to support these measures.
HEV infection is a newly defined cause of acute liver dysfunction among HIV-infected persons in the United States. HEV infections do not seem to preferentially occur among HIV-infected persons, suggesting that HIV itself may not be a risk factor for HEV acquisition. HEV infection should be considered among HIV-infected persons with liver abnormalities of unclear etiology.
Members of The Infectious Disease Clinical Research Program HIV Working Group are Susan Banks, Irma Barahona, Mary Bavaro, Helen Chun, Cathy Decker, Lynn Eberly, Conner Eggleston, Susan Fraser, Joshua Hartzell, Gunther Hsue, Arthur Johnson, Mark Kortepeter, Alan Lifson, Michelle Linfesty, Grace Macalino, Scott Merritt, Robert 'Connell, Jason Okulicz, Sheila Peel, Michael Polis, John Powers, Roseanne Ressner, Sybil Tasker, Edmund Tramont, Tyler Warkentien, Paige Waterman, Timothy Whitman, Glenn Wortmann, and Michael Zapor.