Background/introduction Hepatitis E Virus (HEV) is increasing in incidence. Transmission routes include faecal-oral, blood and zoonotically. Patients present with no symptoms; elevated liver enzymes; acute/chronic hepatitis and/or neuropathy. Evidence suggests poorer outcomes among HIV+ patients.
Aim(s)/objectives To describe known cases of HEV/HIV co-infection within a cohort of 2200 HIV+ patients.
Methods We present two cases.
Results Patient-1, a 63-year-old asymptomatic MSM with a 22-year history of HIV, recently re-started Truvada/darunavir/ritonavir: CD4 393(17%) cells/mm3 and HIV VL 327,824 copies/ml. Routine bloods identified newly elevated ALT 477 IU/L: other liver function, clotting and liver ultrasound were normal. He had no STIs diagnosed in the preceding year nor risk factors for HEV. A hepatitis screen was performed. HEV IgG, IgM and PCR were positive. Treatment was supportive, with normalisation of ALT and negative HEV-PCR after eight weeks. Patient-2, a 41-year-old asymptomatic MSM with an 11-year history of HIV was ART naive: CD4 682(25%) cells/mm3 and HIV VL 13,109 copies/ml. Routine bloods identified newly elevated ALT 459 IU/L: other liver function, clotting and liver ultrasound were normal. He had no STIs diagnosed in the preceding year nor risk factors for HEV. Although HEV serology was initially equivocal, IgG and IgM later became positive with detectable PCR. His ALT normalised and HEV-PCR became undetectable four weeks later.
Discussion/conclusion HEV appears to be a self-limiting-asymptomatic illness in HIV+ MSM with good CD4 counts. HEV may be sexually transmitted in populations with increasing STI rates. HEV should be considered a potential cause of elevated liver enzymes in HIV+ patients.