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Volume 18, Number 3—March 2012

Dispatch

Hepatitis E Virus Infection in HIV-infected Persons

Nancy F. Crum-CianfloneComments to Author , Jennifer Curry, Jan Drobeniuc, Amy Weintrob, Michael Landrum, Anuradha Ganesan, William Bradley, Brian K. Agan, Saleem Kamili, and The Infectious Disease Clinical Research Program HIV Working Group
Author affiliations: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (N.F. Crum-Cianflone, J. Curry, A. Weintrob, M. Landrum, A. Ganesan, W. Bradley, B.K. Agan); Naval Medical Center San Diego, San Diego, California, USA (N.F. Crum-Cianflone); Naval Medical Center Portsmouth, Portsmouth, Virginia, USA (J. Curry); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J. Drobeniuc S. Kamili); Walter Reed Army Medical Center, Washington DC, USA (A. Weintrob); San Antonio Military Medical Center, San Antonio, Texas, USA (M. Landrum); National Naval Medical Center, Bethesda (A. Ganesan)

Main Article

Table 1

Characteristics of 194 HIV-positive US military beneficiaries at time of ALT increase, 1985–2009*

Characteristic† Total cohort HEV seropositive,‡
n = 13 HEV seronegative,
n = 181 Odds ratio p value
Demographics
Age, y 34 (30–40) 35 (32–40) 34 (29–40) 1.01 0.66
Male gender 185 (95) 13 (100) 172 (95)
Ethnicity 0.4
White 82 (42) 7 (54) 75 (41) Referent
African American 77 (40) 4 (31) 73 (40) 0.59
Hispanic 29 (15) 1 (8) 28 (16) 0.38
Other 6 (3) 1 (8) 5 (3) 2.14
Military status 0.32
Active duty 98 (50) 4 (31) 94 (52) Referent
Retired 85 (44) 8 (61) 77 (43) 2.44
Spouse/dependent 11 (6) 1 (8) 10 (5) 2.35
Overseas travel§ 48/127 (38) 1/5 (20) 47/122 (39) 0.4 0.65
Liver function test results
Timing of blood collection after ALT increase, d 27 (0–104) 31 (7–107) 23 (0–105) 1.0 0.78
ALT level, IU/L 440 (322–812) 367 (241–483) 454 (333–821) 0.99 0.63
AST level, IU/L 262 (183–653) 297 (152–474) 260 (185–693) 1.0 0.66
Clinical conditions
Gonorrhea§ 54 (28% 2 (15) 52 (29) 0.44 0.36
Chlamydia/nonspecific urethritis§ 20 (10) 1 (8) 19 (11) 0.7 1.0
Syphilis§ 32 (17) 4 (31) 28 (16) 2.38 0.24
Any STI§¶ 84 (44) 6 (46) 78 (44) 1.1 1.0
Hepatitis B#
Prior infection 97 (51) 8 (62) 89 (50) 1.6 0.57
Chronic 30 (15) 3 (23) 27 (15) 1.69 0.43
Hepatitis C# 12 (6) 2 (15) 10 (6) 3.05 0.19
HIV–specific factors
HIV infection duration, y 5 (1.8–8.8) 5.3 (2.3–10.0) 4.9 (1.7–8.6) 1.01 0.89
CD4 cell count, cells/mm3 436 (239–627) 217 (9–589) 439 (258–633) 0.79 0.07
<200 40 (21) 6 (46) 34 (19) Referent
200–499 80 (41) 3 (23) 77 (42) 0.22 0.06
>500 74 (38) 4 (31) 70 (39) 0.32 0.10
Median HIV RNA level, log10 copies/mL§ 4.1 (2.9–4.9) 4.7 (3.9–5.4) 4.1 (2.9–4.8) 1.96 0.04
HIV RNA copies/mL
<1,000 48 (27) 1 (9) 47 (28) Referent
1,000–10,000 36 (20) 2 (18) 34 (20) 2.76 0.57
>10,000 96 (53) 8 (73) 88 (52) 4.27 0.27
Antiretroviral drug use 55 (28) 1 (8) 54 (30) 0.2 0.12

*ALT, alanine aminotransferase; HEV, hepatitis E virus; AST, aspartate aminotransferase; STI, sexually transmitted infection.
†Characteristics are expressed as number (percent) for categorical variables and medians (interquartile range) for continuous variables.
‡IgM and/or IgG against HEV.
§Some data were missing: for overseas travel n = 127; STIs n = 191; HIV RNA level n = 180.
¶Gonorrhea, chlamydial infection, nonspecific urethritis, or syphilis.
#Based on clinical diagnoses; similar results noted when prior hepatitis B virus infection was defined as total positive for hepatitis B virus core antigen, chronic hepatitis B infection as positive for hepatitis B virus surface antigen, and hepatitis C infection as positive for IgG against hepatitis C virus.

Main Article

1Members are listed at the end of this article.

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