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Short article

Association between liver fibrosis and hepatitis E seroprevalence among HIV-positive individuals in Nepal

Shah, Shemal M.a; Baniya, Jagat B.e; Gupta, Birendra Prasadf; Shrestha, Anantad; Rodin, Hollyc; Boonstra, Andreg; Debes, Jose D.a,b,g

European Journal of Gastroenterology & Hepatology: April 2019 - Volume 31 - Issue 4 - p 503–505
doi: 10.1097/MEG.0000000000001308
Original Articles: Hepatology

Objective Hepatitis E virus (HEV) seropositivity may confer an increased risk of liver fibrosis in immunosuppressed individuals. We studied this effect in HIV-infected individuals in Nepal, a country hyperendemic for HEV.

Participants and methods We prospectively evaluated 200 HIV-positive individuals. Serum samples were tested for components of fibrosis scores and cytokeratin-18.

Results Of 200 patients, 43% were HEV-immunoglobulin G+. The mean fibrosis-4 score was 8.02 in the HEV-positive and 1.17 in the HEV-negative group (P<0.001). The mean nonalcoholic fatty liver disease score was 2.12 in the HEV-positive and −2.53 in the HEV-negative group (P=0.02). The mean aminotransferase-platelet ratio index score was 0.37 in the HEV-positive and 0.38 in the HEV-negative group (P=0.9). The mean cytokeratin-18 levels were 119.9 in the HEV-positive group and 158.6 in the HEV-negative group (P=0.08).

Conclusion We found higher fibrosis-4 and nonalcoholic fatty liver disease scores in HEV-HIV-positive individuals, suggesting an increased liver fibrosis profile in this group. Further studies using liver stiffness measurements should be carried out.

aDepartment of Medicine, University of Minnesota

bDepartment of Medicine, Gastroenterology and Hepatology, Hennepin County Medical Center

cAnalytic Center of Excellence, Hennepin County Medical Center, Minneapolis, Minnesota, USA

dDepartment of Hepatology, Liver Foundation Nepal

eDepartment of Microbiology, Kathmandu College of Science and Technology

fDepartment of Virology, Central Diagnostic Laboratory and Research Centre, Kathmandu, Nepal

gDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands

Correspondence to Jose D. Debes, MD, MS, Department of Medicine, University of Minnesota, 420 Delaware Street SE, MMC 250, Minneapolis, Minnesota 55455, USA Tel: +1 612 624 6353; fax: +1 612 625 4410; e-mail:

Received September 8, 2018

Accepted October 22, 2018

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