RESUMO
OBJECTIVE: To look for evidence of hepatitis E virus (HEV) exposure in HIV-infected patients with unexplained elevations of liver stiffness (LS). METHODS: Case-control study conducted in 31 HIV-infected patients with unexplained elevations of LS and in 31 HIV-controls with normal LS, matched by age, sex and CD4 cell-counts. Serum HEV antibodies were tested by two ELISA procedures and by Immunoblot. We defined exposure to HEV as the detection of serum HEV antibodies by at least one of the two ELISA assays, provided that it was confirmed by Immunoblot. A real-time PCR RNA assay was conducted in all plasma samples to identify subjects with active HEV infection. RESULTS: Exposure to HEV was demonstrated, according to the criteria used in this study, in 9 (29%) of the cases, whereas it was shown in 5 (16%) of the controls (p = .3). Serum HEV RNA was detected in none of the controls and in only in one case. This patient had a documented chronic hepatitis E with progression to cirrhosis. CONCLUSIONS: HEV antibodies are frequently found in HIV-infected patients with unexplained liver disease
OBJETIVO: Evaluar la existencia de exposición previa al virus de la hepatitis E (VHE) en pacientes infectados por el VIH con elevaciones inexplicadas de rigidez hepatica (RH). MÉTODOS: Estudio caso-control realizado en 31 pacientes con infección por el VIH y elevaciones inexplicadas de RH y 31 controles infectados por el VIH con RH normal, apareados por edad, sexo y recuento de células CD4. Se investigó la presencia de anticuerpos en suero frente al VHE mediante dos técnicas de ELISA y por Inmunoblot. La exposición previa al VHE se definió como la detección de anticuerpos séricos mediante al menos una de las dos técnicas de ELISA que se confirmó posteriormente mediante Inmunoblot. En todos los pacientes se realizó una PCR en tiempo real para identificar a aquellos pacientes con infección activa por el VHE. RESULTADOS: Se demostró la presencia de exposición previa al VHE, de acuerdo a los criterios usados en el estudio, en 9 (29%) de los casos y en 5 (16%) de los controles (p = 0.3). La PCR en tiempo real confirmó la presencia de RNA del VHE en el suero de uno de los casos y en ninguno de los controles. Este paciente presentó una hepatitis crónica por VHE documentada con progresión a cirrosis. CONCLUSIONES: Los pacientes infectados por VIH con enfermedad hepática de origen inexplicado presentan una frecuencia elevada de anticuerpos frente al VHE
Assuntos
Humanos , Anticorpos Anti-Hepatite/análise , Hepatite E/epidemiologia , Infecções por HIV/complicações , Vírus da Hepatite E/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Coinfecção/epidemiologia , Cirrose Hepática/epidemiologiaRESUMO
INTRODUCCIÓN: La prevalencia de hepatitis C es menor en los nuevos casos de pacientes infectados por VIH en España. El uso creciente del tratamiento frente al VHC podría haber cambiado la distribución genotípica del VHC. El objetivo de este estudio fue analizar los cambios en la prevalencia de la coinfección por VHC y en la distribución genotípica del VHC en pacientes infectados por VIH. Métodos Estudio de prevalencia seriada. Se incluyeron todos los pacientes infectados por VIH que acudieron a las consultas de un hospital de Andalucía entre septiembre de 2008 y febrero de 2009 (primer periodo) y entre enero y junio de 2013 (segundo periodo).Resultados Se incluyeron 520 y 651 pacientes en el primer y segundo periodos, respectivamente. El factor de riesgo de infección por VHC en el primer y segundo periodo fue: UDVP 319 (61%) vs. 348 (53%); contacto heterosexual, 111 (21%) vs. 135 (21%); homosexual, 76 (15%) vs. 114 (22%) (p = 0,006). La prevalencia de anti-VHC por periodos fue del 69% vs. el 58% (p=<0,001), y la de ARN-VHC detectable fue 49% vs. 37% (p=<0,001). En ambos periodos, la distribución genotípica fue: 1, 137 (60%) vs. 138 (59%); 3, 45 (20%) vs. 42 (18%); 4, 42 (18%) vs. 47 (20%) (p = 0,881). CONCLUSIONES: La prevalencia de infección por el VHC ha disminuido en los pacientes infectados por VIH en nuestro medio, incluyendo tanto la exposición al virus como la infección activa, en los últimos 5 años. Sin embargo, la distribución de los genotipos del VHC no ha cambiado
BACKGROUND: The prevalence of hepatitisC is decreasing among new diagnoses of HIV/HCV coinfection in Spain. The increasing use of the HCV treatment could have changed the HCV genotype distribution. The aim of this study is to analyze changes in the prevalence of HCV coinfection and in HCV genotype distribution among HIV-infected patients. METHODS: A serial cross-sectional study was conducted that included all HIV-infected patients who attended the Outpatient Clinic of a hospital in Andalusia, between September 2008 and February 2009 (first period), and between January 2013 and June 2013 (second period). RESULTS: A total of 520 and 651 patients were included in the first and second period, respectively. The risk factors of HCV infection in the first vs. second period were: IDU, 319 (61%) vs. 348 (53%); heterosexual contact, 111 (21%) vs. 135 (21%); homosexual men, 76 (15%) vs. 114 (22%) (P=.006). The prevalence of HCV antibody per period was: 358 (69%) vs. 380 (58%) (P=<.001), and for the HCV-RNA was 255 (49%) vs. 240 (37%) (P=<.001). In both periods, the HCV genotype distribution was: 1, 137 (60%) vs. 138 (59%); 3, 45 (20%) vs. 42 (18%); 4, 42 (18%) vs. 47 (20%) (P=.881). CONCLUSIONS: The prevalence of HCV infection in HIV-infected patients has decreased in our area, including overall exposure to HCV virus and active infection during the last 5 years. However, the HCV genotype distribution has not changed
Assuntos
Humanos , Infecções por HIV/complicações , Hepatite C Crônica/complicações , Antivirais/uso terapêutico , Prevalência , Coinfecção/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Técnicas de Genotipagem/métodos , Interferons/uso terapêutico , Ribavirina/uso terapêuticoRESUMO
OBJECTIVE: To look for evidence of hepatitis E virus (HEV) exposure in HIV-infected patients with unexplained elevations of liver stiffness (LS). METHODS: Case-control study conducted in 31 HIV-infected patients with unexplained elevations of LS and in 31 HIV-controls with normal LS, matched by age, sex and CD4 cell-counts. Serum HEV antibodies were tested by two ELISA procedures and by Immunoblot. We defined exposure to HEV as the detection of serum HEV antibodies by at least one of the two ELISA assays, provided that it was confirmed by Immunoblot. A real-time PCR RNA assay was conducted in all plasma samples to identify subjects with active HEV infection. RESULTS: Exposure to HEV was demonstrated, according to the criteria used in this study, in 9 (29%) of the cases, whereas it was shown in 5 (16%) of the controls (p=.3). Serum HEV RNA was detected in none of the controls and in only in one case. This patient had a documented chronic hepatitis E with progression to cirrhosis. CONCLUSIONS: HEV antibodies are frequently found in HIV-infected patients with unexplained liver disease.
Assuntos
Infecções por HIV/complicações , Anticorpos Anti-Hepatite/sangue , Vírus da Hepatite E/imunologia , Hepatite E/complicações , Adulto , Estudos de Casos e Controles , Elasticidade , Ensaio de Imunoadsorção Enzimática , Feminino , Hepatite E/diagnóstico , Hepatite E/imunologia , Vírus da Hepatite E/genética , Humanos , Immunoblotting , Fígado/patologia , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Reação em Cadeia da Polimerase em Tempo Real , Estudos SoroepidemiológicosRESUMO
BACKGROUND: The prevalence of hepatitisC is decreasing among new diagnoses of HIV/HCV coinfection in Spain. The increasing use of the HCV treatment could have changed the HCV genotype distribution. The aim of this study is to analyze changes in the prevalence of HCV coinfection and in HCV genotype distribution among HIV-infected patients. METHODS: A serial cross-sectional study was conducted that included all HIV-infected patients who attended the Outpatient Clinic of a hospital in Andalusia, between September 2008 and February 2009 (first period), and between January 2013 and June 2013 (second period). RESULTS: A total of 520 and 651 patients were included in the first and second period, respectively. The risk factors of HCV infection in the first vs. second period were: IDU, 319 (61%) vs. 348 (53%); heterosexual contact, 111 (21%) vs. 135 (21%); homosexual men, 76 (15%) vs. 114 (22%) (P=.006). The prevalence of HCV antibody per period was: 358 (69%) vs. 380 (58%) (P=<.001), and for the HCV-RNA was 255 (49%) vs. 240 (37%) (P=<.001). In both periods, the HCV genotype distribution was: 1, 137 (60%) vs. 138 (59%); 3, 45 (20%) vs. 42 (18%); 4, 42 (18%) vs. 47 (20%) (P=.881). CONCLUSIONS: The prevalence of HCV infection in HIV-infected patients has decreased in our area, including overall exposure to HCV virus and active infection during the last 5 years. However, the HCV genotype distribution has not changed.
Assuntos
Coinfecção , Infecções por HIV/complicações , Hepacivirus/genética , Hepatite C/complicações , Hepatite C/virologia , Adulto , Estudos Transversais , Feminino , Genótipo , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
OBJECTIVES: To know the prevalence, incidence and factors associated with hepatitis E virus (HEV) infection in HIV-infected individuals in Spain, as well as to provide information on the natural history of HIV/HEV coinfection. DESIGN: Prospective cohort study. METHODS: Serum HEV IgG antibodies were tested in 613 HIV-infected patients at baseline and 2 years thereafter. Positive samples were tested for HEV-RNA. In patients with seroconversion, changes in liver function tests, serum HEV IgM antibodies and HEV RNA in samples collected between the baseline and the final time points were analyzed. RESULTS: One hundred and sixty-one (26%) patients tested positive for serum HEV IgG antibodies at baseline. HEV exposure was more common in men than in women (28 vs. 18%; P = 0.022) and increased linearly with age: 16, 26 and 44% in younger than 40, from 40 to 49 and older than 50 years, respectively (P = 0.000002). One patient bore the serum HEV-RNA at baseline. Eighteen (4%) HEV-seronegative patients seroconverted during the follow-up. None of the factors predicted seroconversion. One patient with seroconversion developed acute hepatitis and four mild hypertransaminasemia without another apparent cause. No case of seroconversion evolved to chronic HEV infection. Seroreversion was detected in 19% of the HEV-seropositive patients at baseline. Patients with seroreversion showed more commonly CD4 cell counts below 500 cells/µl than those who remained seropositive (77 vs. 46%; P = 0.004). CONCLUSIONS: Exposure to HEV among HIV-infected patients in Spain is very common, and this increases with age. Evolution to chronic infection is extremely unusual. Most cases of acute HEV infection seem to be clinically and biochemically unexpressive, therefore going unnoticed.
