1. Seroepidemiology of Hepatitis E Virus Infection in an Urban Population in Zambia: Strong Association With HIV and Environmental Enteropathy
- Author
-
Philip C. Hill, Samreen Ijaz, Mumba Chomba, Mpala Mwanza Lisulo, Paul Kelly, Clarance Chiluba, Cynthia Phiri, and Choolwe Jacobs
- Subjects
Adult ,Male ,Adolescent ,Urban Population ,viruses ,030231 tropical medicine ,Zambia ,HIV Infections ,hepatitis E virus ,medicine.disease_cause ,Major Articles and Brief Reports ,03 medical and health sciences ,0302 clinical medicine ,Hepatitis E virus ,Seroepidemiologic Studies ,medicine ,Humans ,Immunology and Allergy ,Hepatitis Antibodies ,030212 general & internal medicine ,Child ,Hepatitis ,Environmental enteropathy ,seroprevalence ,Coinfection ,business.industry ,Transmission (medicine) ,HIV Enteropathy ,Infant ,virus diseases ,Hepatitis A ,HIV infection ,medicine.disease ,Hepatitis E ,Virology ,environmental enteropathy ,3. Good health ,Infectious Diseases ,Immunoglobulin M ,Child, Preschool ,Immunoglobulin G ,Viruses ,Immunology ,Female ,epidemiology ,business - Abstract
Epidemics of jaundice, characterized by a high mortality rate in pregnant women, have been recorded for >200 years [1]. The causative virus of this form of non-A, non-B hepatitis was recognized in 1983 to be hepatitis E virus (HEV), a nonenveloped, single-stranded RNA virus that has only 1 serotype but 4 major genotypes [2]. It is one of the leading causes of hepatitis globally, and epidemics can be very large with 29 300 cases recorded in Delhi in 1954–1955 [1]. Throughout the developing world, case fatality rates of up to 73% in pregnancy have been recorded, although the highest figures derived from hospital records probably reflect selection bias toward the most severe cases. Incidence rates in the developing world are hard to estimate, but one study in Bangladesh calculated the rate at 60.3 per 1000 person-years [3]. More recently, the development of chronic hepatitis linked to HEV infection has been described in immunosuppressed patients [4–6]. These studies report a persistence of HEV RNA as well as progression of liver inflammation and fibrosis with HEV-related cirrhosis also being described. Such infections were initially reported in the transplant setting but have now also been observed in hematological patients receiving chemotherapy and in patients infected with human immunodeficiency virus (HIV). As areas of high HIV prevalence overlap widely with regions where HEV is common, the potential for coinfection will be high, which may lead to the emergence of comorbidity. This will be of particular significance in the developing world, which bears the brunt of the HIV pandemic. However, there are few data on HEV epidemiology in African populations and this area remains poorly investigated. Transmission of HEV in the developing world is fecal-oral as with hepatitis A virus, but unlike hepatitis A virus infection, antibody levels wane over time. Whether this reflects imperfect serological tests or a genuine difference in the immune response is uncertain, but there is some evidence that early childhood infection does not protect against reinfection in adulthood [2]. Transmission of HEV through the developing world is via the fecal-oral route linked to contaminated food and water. We have previously reported that tropical enteropathy shows strong evidence of environmental causation, with pronounced seasonal effects and relationships to poor housing and asymptomatic intestinal carriage of pathogens [7]. We now refer to this phenomenon as environmental enteropathy [8], as it is not exclusive to the tropics and there are tropical populations (such as Qatar and Singapore) where it is not found [9]. We set out to investigate the seroepidemiology of HEV infection in both children and adults from a poor township of Lusaka, Zambia. Additional analyses were undertaken to explore associations between HEV and HIV infection and also with environmental enteropathy. more...
- Published
- 2013
- Full Text
- View/download PDF