Persistent HEV with detectable RNA has been observed at low frequencies in solid organ transplant populations. In HIV-infected patients,

seroprevalence rates have been found to be 2.6–9%, and in those with unexplained elevated transaminases approximately 0.05% have been found to have chronic HEV/HIV infection. However, the number of studies evaluating this in large numbers of HIV-infected patients is small, and none have selleckchem used the most sensitive serological assay for screening. Persistent HEV infection has been described in individuals with undetectable HEV IgG [7–8] and the use of anti-HEV IgG for the diagnosis of HEV infection in patients with CD4 counts below 200 cells/μL may be inappropriate. Host factors associated with HEV persistence in organ transplant recipients include lower CD4+ T cell counts and tacrolimus (as opposed to cyclosporine) therapy. A single study has revealed a higher prevalence rate in those with AIDS, compared to those with HIV infection at other stages [9]. Persistent HEV has been identified as a cause for liver cirrhosis in immunosuppressed patients [9]. In those with persistent HEV and solid organ transplants, HEV viral clearance has been obtained either (i) through the reduction of immunosuppressive therapy or (ii) following treatment. To date there http://www.selleckchem.com/products/Lapatinib-Ditosylate.html are fewer than 10 individuals with HIV infection

and detectable HEV RNA described in the literature, but one small case series would recommend initial use of ribavirin alone [10] and, if this fails to eradicate infection, the addition of or a switch to PEG-IFN [11]. 1  Aggarwal R. Clinical presentation of hepatitis E. Virus Res 2011; 161:15–22. 2  Kumar A, Beniwal M, Kar P, Sharma JB, Murthy NS. Hepatitis E in pregnancy. Int J Gynaecol Obstet 2004; 85:240–244. 3  Kumar A, Aggarwal R, Naik SR, Saraswat V, Ghoshal UC, Naik S. Hepatitis E virus is responsible for decompensation of chronic

liver disease in an endemic region. Indian J Gastroenterol 2004; 23: 59–62. 4  Dalton HR, Stableforth W, Thurairajah P et al. Autochthonous hepatitis E in Southwest England: natural history, complications and seasonal variation, and hepatitis E virus IgG seroprevalence in blood donors, the elderly and patients with chronic liver disease. Eur J Gastroenterol Hepatol 2008; 20: 784–790. 5  Mansuy JM, Bendall R, Legrand-Abravanel F et al. Hepatitis Thiamine-diphosphate kinase E virus antibodies in blood donors, France. Emerg Infect Dis 2011; 17: 2309–2312. 6  Gessoni G, Manoni F. Hepatitis E virus infection in north-east Italy: serological study in the open population and groups at risk. J Viral Hepat 1996; 3: 197–202. 7  Kaba M, Richet H, Ravaux I et al. Hepatitis E virus infection in patients infected with the human immunodeficiency virus. J Med Virol 2011; 83: 1704–1716. 8  Kenfak-Foguena A, Schöni-Affolter F, Bürgisser P et al. Hepatitis E virus seroprevalence and chronic infections in patients with HIV, Switzerland. Emerg Infect Dis 2011; 17: 1074–1078.