Seroepidemiology and role of polymerase chain reaction to detect viremia in an epidemic of hepatitis E in Western India.

AIM: In an outbreak of hepatitis E affecting 859 individuals, we evaluated the titres of serological markers (IgM anti-HEV and IgG anti-HEV) and hepatitis E virus (HEV) RNA by reverse transcriptase polymerase chain reaction. METHODS: Serological markers for acute hepatitis were evaluated in 294 icteric patients (Group A) and 300 apparently healthy controls (Group B). HEV RNA was measured by RT nPCR in 19 patients in the first week of illness in patients with negative IgM anti-HEV. FINDINGS: None of the patients were positive for hepatitis A or B. In Group A, IgM anti-HEV was positive in 80.2%, 71.4% and 26.8% and IgG anti-HEV was positive in 58.3%, 77.1% and 86% of patients who were in their first, second and third weeks of illness, respectively. In Group A, amongst the 19 IgM anti-HEV negative patients in their first week of illness, 16 were positive for HEV RNA. In Group B 63.6% cases were positive for IgM anti-HEV. In the same village there had been a similar epidemic 4 years ago; none of the 93 patients traced from that time developed acute hepatitis during the present epidemic and all demonstrated the presence of IgG anti-HEV. This suggests that IgG anti-HEV was perhaps protective. CONCLUSION: During the first week of illness patients may display HEV viremia while testing negative for IgM and IgG anti-HEV. The presence of IgG anti-HEV may play a protective role against HEV infection and in the absence of IgM may help in diagnosing acute hepatitis E. Over 3 weeks of illness the IgM anti-HEV titres fall progressively whilst IgG anti-HEV titres gradually rise.

Prevalence of occult hepatitis B & C in HIV patients infected through sexual transmission.

BACKGROUND: Prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) markers including active and occult infection has not been described in diverse cohorts among HIV-infected patients in India. Earlier studies have explained the role of HBV/HCV co-infection in cohorts of injection drug users (IDUs) but the sexual co-transmission of HBV/ HCV is not completely understood. OBJECTIVE: The objective of this study was to assess the prevalence of occult HBV & HCV infection in HIV positive sexually acquired transmission risk group. MATERIALS AND METHODS: 58 sexually acquired HIV positive patients were taken up for the study of occult HBV/HCV co-infection. Data on demographics, sexual behaviour, sexually transmitted diseases (STD), medical history, laboratory tests viz., serum ALT and CD4 count were recorded. HBV serology included HBsAg, anti HBs, IgG anti HBc and HBV DNA (PCR). HCV serology included anti HCV & HCV RNA (RT-PCR). RESULTS: Occult HBV infection (HBV DNA) was observed in 12.2% (7/58 with HBsAg -ve and IgG anti HBc +ve subjects) while an overall prevalence of HBV DNA was 13.7% (12% occult & 1.7% in HBsAg+ve patients). Out of 58 HIV positive patients 29.3% demonstrated reactivity for any marker of past or current HBV infection. (HBsAg 1.7%, anti HBs 10.3% anti HBc IgG 17.2%). 4/58 (6.8%) revealed anti HCV positivity along with HCV RNA positivity by RT-PCR while 6/58 (10.3%) individuals revealed an occult HCV infection (anti HCV negative). The overall HCV RNA prevalence was 17.2%. 2 out of 58 (3.4%) individuals were positive for occult infection of both HBV DNA & HCV RNA (Triple infection HIV/HBV/ HCV). The HBV/HCV co-infected group (n = 18) showed a significantly high ALT (114.3 + 12.3 U/I) & low CD4 count (202.5 + 33.7 cells/mm3). The percent prevalence of HBV/ HCV co-infection was higher in the illiterate group, in men less than 30 years of age, and in those who were married and exhibited polygamous activity. CONCLUSIONS: The study demonstrated that in HIV infected patients testing only serological viral markers like HBsAg, antiHBcIgG & anti HCV, fails to identify the true prevalence of co-infection with HBV & HCV. Qualitative PCR for HBV DNA & HCV RNA detects co-infection in patients who are negative for serological markers. Also, in subjects who had only a sexual risk factor for parenterally transmitted infections, HIV may enhance the sexual transmission of HBV and HCV.