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Acute Hepatitis E Virus Infection in an HIV-Infected Person in the United States

Jennifer A. Curry, MD; Nehkonti Adams, MD; and Nancy F. Crum-Cianflone, MD, MPH
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From Naval Medical Center, San Diego, CA 92134, and Uniformed Services University of Health Sciences, Bethesda, MD 20814.

Note: The opinions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Departments of the Army, Navy, or Air Force or the Department of Defense. The authors have no commercial or other association that might pose a conflict of interest in this work. This work is original and has not been published elsewhere.

Grant Support: By the Infectious Disease Clinical Research Program (IDCRP), Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, of which the TriService AIDS Clinical Consortium is a component. The IDCRP is a Department of Defense tri-service program executed through USUHS and the Henry M. Jackson Foundation for the Advancement of Military Medicine in collaboration with the Department of Health and Human Services/National Institutes of Health/National Institute of Allergy and Infectious Diseases/Department of Conservation and Recreation through Interagency Agreement HU0001-05-2-0011.

Potential Financial Conflicts of Interest: None disclosed.

Ann Intern Med. 2009;150(3):226-227. doi:10.7326/0003-4819-150-3-200902030-00028
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Comment on: Acute Hepatitis E Virus Infection in an HIV-Infected Person in the United States
Posted on June 4, 2009
Jan Thoden
University Hospital Freiburg Medical Center, Dept. Rheumatology and Clin. Immunol, Freiburg, Germany
Conflict of Interest: None Declared

Curry et al. (1) presented the case of an acute hepatitis E (HEV)- infection in an HIV-infected man without any travel history in the February edition of this journal. The diagnosis was confirmed both by serology (HEV-IgM and HEV-IgG) and HEV-PCR. The authors concluded this to be the first case of its kind.

We therefore want to point out, that our own group previously described the case of a 32-year old HIV-positive pregnant woman who presented with acute HEV-infection without a recent travel history outside Germany. She also recovered uneventfully after beginning liver failure and gave birth to a healthy child (2).

Colson et al. described another HIV-infected patient with acute HEV in France who lacked a travel history in late 2008. The authors report a favourable outcome, too. In contrast to our own case which was confirmed by HEV-seroconversion, the authors confirmed HEV by serology (HEV-IgM and HEV-IgG) and PCR (3).

In conclusion we find it important to point out that at least two intensively worked up and well documented cases of acute HEV-infection in HIV-infected individuals had previously been published and should have been cited by the authors. All three cases have in common that HEV was acquired in non-endemic countries in patients without a recent travel history and all patients fully recovered from hepatitis. HEV therefore should be considered and excluded as cause of acute hepatitis or liver failure in HIV-positive patients in non-HEV-endemic countries.

References: 1: Curry JA, Adams N, Crum-Cianflone NF. Acute hepatitis E virus infection in an HIV-infected person in the United States. Ann Intern Med. 2009 Feb 3;150(3):226-7. [PMID: 19189925].

2: Thoden J, Venhoff N, Miehle N, Klar M, Huzly D, Panther E, Jilg N, Kunze M, Warnatz K. Hepatitis E and jaundice in an HIV-positive pregnant woman. AIDS. 2008 Apr 23;22(7):909-10. [PMID: 18427215].

3: Colson P, Dhiver C, Gérolami R. Hepatitis E virus as a newly identified cause of acute viral hepatitis during human immunodeficiency virus infection. Clin Microbiol Infect. 2008 Dec;14(12):1176-80. Epub 2008 Nov 22. [PMID: 19046170].

Conflict of Interest:

None declared

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