Hepatitis E in HIV-Infected Patients

 描述（由申请人提供）： 戊型肝炎病毒（HEV）是一种RNA病毒，可引起HIV感染者或实体器官移植后的急性肝炎和慢性肝病。HIV实体器官移植研究（HIV Solid Organ Transplant Study，HIVTR）是一项针对接受肝脏和/或肾脏移植的HIV感染成人的多中心队列研究。HCVRES和HEPRO是NIH队列研究，收集了HIV-HCV感染患者和HCV对照的数据和样本。将对总计589例HIV感染患者和非HIV对照进行HEV感染评价。HIVTR队列的初步数据表明，在移植前，超过20%的受试者有既往感染的血清学证据，近2%的肝脏候选人最近有急性感染。该提案旨在确定美国HIV感染者中HEV的流行率、发病率和临床意义。此外，我们将评估慢性化的免疫学和病毒学相关性以及与肝损伤的相关性。我们建议使用经验证的检测方法以及实时PCR进行HEV RNA表征来进行HEV血清学的纵向评价。我们实验室开发的敏感的HEV ELISPOT检测将用于评估血清阴性病例以及与既往感染、偶发疾病和慢性风险的关系。使用队列数据库，我们将评估HEV感染持续和清除的临床相关性。此外，将确定慢性感染患者的自然史，包括进展为肝硬化的风险、对其他复发性病毒感染（HBV和HCV）的影响以及移植队列中移植物丢失的风险。的 预期的结果将为今后对艾滋病毒感染者的监测工作提供参考。

 DESCRIPTION (provided by applicant): Hepatitis E Virus (HEV) is an RNA virus associated that can cause both acute hepatitis and chronic liver disease in those with HIV or following solid organ transplantation. The HIV Solid Organ Transplant Study (HIVTR) is a multicenter cohort study of HIV-infected adults who received liver and/or kidney transplantation. HCVRES and HEPRO are NIH Cohort Studies that collected data and samples on HIV-HCV infected patients and HCV controls. A total of 589 HIV infected patients plus non-HIV controls will be evaluated for HEV infection. Preliminary data in the HIVTR cohort demonstrates that prior to transplant over 20% of subjects had serologic evidence of prior infection and nearly 2% of liver candidates had recent acute infection. This proposal is designed to determine the prevalence, incidence and clinical significance of HEV in the HIV infected persons in the U.S.. Furthermore, we will evaluate immunologic and virologic correlates of chronicity and the association with liver injury. We propose to perform longitudinal evaluation of HEV serologies using a validated assay methodology as well as HEV RNA characterization by real-time PCR. A sensitive HEV ELISPOT assay developed in our laboratory will be employed to evaluate seronegative cases and the relationship to prior infection, incident disease and risk of chronicity. Using the cohort databases we will assess the clinical correlates of HEV infection persistence and clearance. Additionally, the natural history of those with chronic infection will be determined, including risk of progression to cirrhosis, effect on other recurrent viral infections (HBV and HCV), and in the transplant cohort, the risk of graft loss. The anticipated results will inform future surveillance practices in HIV-infected persons.