HIV, HEV and cirrhosis: evidence of a possible link from eastern Spain

HIV Med. 2012 Jul;13(6):379-83. doi: 10.1111/j.1468-1293.2011.00985.x. Epub 2012 Jan 18.


Objectives: The aim of the study was to assess the seroprevalence of hepatitis E virus (HEV) infection in an HIV-infected population, as determined by HEV immunoglobulin G (IgG) antibodies (anti-HEV).

Methods: The design of the study was cross-sectional. Serum anti-HEV IgG was determined by enzyme immunoassay in 238 HIV-infected patients consecutively attending our out-patient clinic between April and May 2011. In HEV-seropositive patients, HEV RNA was analysed by nested reverse transcriptase-polymerase chain reaction (RT-PCR). Associations between anti-HEV and liver cirrhosis, route of HIV infection, hepatitis B virus (HBV) and hepatitis C virus (HCV) serological markers, age, sex and alanine aminotransferase (ALT) levels were examined by univariate and multivariate analysis.

Results: One hundred and forty patients (59%) had chronic liver disease (99% were HBV- and/or HCV-coinfected). Liver cirrhosis was detected in 44 individuals (19%). Two hundred and twelve patients (89%) were on antiretroviral treatment; the median CD4 T-cell count was 483 cells/μL [interquartile range (IQR) 313-662 cells/μL] and the HIV viral load was <25 HIV-1 RNA copies/mL. Overall, 22 patients (9%) were anti-HEV positive. Liver cirrhosis was the only factor independently associated with the presence of anti-HEV, which was documented in 23% of patients with cirrhosis and 6% of patients without cirrhosis (P=0.002; odds ratio 5.77). HEV RNA was detected in three seropositive patients (14%), two of whom had liver cirrhosis.

Conclusions: Our findings show a high prevalence of anti-HEV in HIV-infected patients, strongly associated with liver cirrhosis. Chronic HEV infection was detected in a significant number of HEV-seropositive patients. Further research is needed to ascertain whether cirrhosis is a predisposing factor for HEV infection and to assess the role of chronic HEV infection in the pathogeneses of cirrhosis in this population.

MeSH terms

  • Adult
  • Antibodies, Viral / blood*
  • CD4 Lymphocyte Count
  • Female
  • HIV Seropositivity / epidemiology*
  • HIV Seropositivity / genetics
  • HIV Seropositivity / immunology
  • Hepatitis E / epidemiology*
  • Hepatitis E / genetics
  • Hepatitis E / immunology
  • Hepatitis E virus / genetics
  • Hepatitis E virus / immunology*
  • Humans
  • Immunoglobulin G / blood
  • Liver Cirrhosis / epidemiology*
  • Liver Cirrhosis / genetics
  • Liver Cirrhosis / immunology
  • Male
  • Middle Aged
  • RNA, Viral / blood
  • Reverse Transcriptase Polymerase Chain Reaction
  • Spain / epidemiology


  • Antibodies, Viral
  • Immunoglobulin G
  • RNA, Viral