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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)

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Table 2

Characteristics of HIV-positive US military beneficiaries with acute HEV infection at time of ALT increase, 1985–2009*

Patient 1 2 3 4 5 6 7
Age, y 34 35 35 33 44 41 30
Ethnicity White African-American White African-American White African-American African-American
Duty status Active Retired Active Retired Retired Retired Retired
Year of ALT increase 2001 1995 2000 2006 1989 1996 1996
Clinical presentation Nausea, vomiting, abdominal pain, pale stools, dark urine Fever, malaise, anorexia, diarrhea, dark urine, icterus Fever, nausea, vomiting, diarrhea, abdominal pain, loss of appetite, malaise Jaundice Abdominal pain Asymp Asymp
Peak ALT, U/L 489 2,540 282 2,829 229 477 226
AST, U/L 354 988 174 4,273 209 508 130
Alkaline phosphatase, U/L 80 153 99 409 157 125 137
Total bilirubin, mg/dL
3.2
5.0
1.9
5.3
1.6
0.5
1.2
Antibodies against
Hepatitis B virus core
antigen Neg Pos Pos Pos Neg Pos Pos
Hepatitis B virus
surface antigen Neg Neg Neg Pos Neg Pos Neg
Hepatitis C virus
Neg
Neg
Neg
Neg
Neg
Neg
Pos
History of STI since HIV Infection None None None Syphilis and chlamydia infections Gonorrhea Syphilis Gonorrhea
Travel overseas NK NK Kuwait NK NK NK NK
Duration of HIV, y 11 2 <1 13 2 8 9
CD4 count, cells/mm3 822 517 660 454 753 98 217
HIV RNA level, copies/mL 427 52,929 6,854 52,682 40,000 430,946 8,068
HAART received Yes No No No No No† No‡
HEV serostatus IgG sero and HEV RNA IgG sero IgM and IgG positivity IgG sero IgG sero IgG sero IgM with persistent positivity

*All patients were male; none had evidence of acute hepatitis A virus infection or chronic HEV. HEV, hepatitis E infection; ALT, alanine aminotransferase; asymp, asymptomatic; AST, aspartate aminotransferase; neg, negative; pos, positive; STI, sexually transmitted infection; NK, none known; HAART, highly active antiretroviral therapy; sero, seroconversion.
†Patient was receiving monotherapy with zalcitabine.
‡Patient was receiving dual therapy with stavudine and ritonavir.

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1Members are listed at the end of this article.

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