Hepatitis E virus epidemiology among HIV-infected women in an urban area in Tanzania.

OBJECTIVES: This study was performed to determine the seroprevalence and incidence of hepatitis E virus (HEV) infection among HIV-infected women during pregnancy and after delivery in a cohort of 200 Tanzanian women. METHODS: HIV-infected women participating in a study on antiretroviral therapy for the prevention of mother-to-child HIV transmission between 2006 and 2011, were tested retrospectively for anti-HEV immunoglobulin G (IgG) in plasma samples at 9 months post-partum. Anti-HEV IgG-positive patients were tested for anti-HEV IgG and immunoglobulin M (IgM) in samples from enrolment, and seroconverting women were tested for HEV RNA. RESULTS: A total of 16 women were anti-HEV IgG-positive, two of whom had seroconverted between enrolment and 9 months post-partum, with no detection of anti-HEV IgM or HEV RNA, yielding an HEV seroprevalence of 8.0% (confidence interval 5.0-12.6%) and an annual incidence rate of 1.0% (confidence interval 0.2-3.4%). CD4 cell counts were relatively high (median 403×106/l), with no significant difference between women with and without serological signs of HEV. CONCLUSIONS: An annual HEV infection incidence rate of 1% strongly indicates ongoing transmission of HEV in Tanzania and should be kept in mind for pregnant women presenting with signs of acute hepatitis.

[Hepatitis E and pregnancy].

Hepatitis E virus (HEV) infection among pregnant women is severe, often leading to fulminant hepatic failure and death, with mortality rates up to 15-25%. Studies suggest that differences in genotypes/subgenotypes, hormonal and immunological changes during pregnancy may contribute to the severe consequences for pregnant women with HEV. Although the increased mortality among pregnant women predominantly is seen in developing countries where genotype 1 is endemic, there are also large differences in mortality among pregnant women within these countries. The reason for this is not clear.