# Hepatitis E virus infection in sheltered homeless persons, France

Sylvie Larrat, Stéphanie Gaillard, Monique Baccard, Lionel Piroth, Patrice

Cacoub, Stanislas Pol, Christian Perronne, Fabrice Carrat, Patrice Morand

► To cite this version:

Sylvie Larrat, Stéphanie Gaillard, Monique Baccard, Lionel Piroth, Patrice Cacoub, et al.. Hepatitis E virus infection in sheltered homeless persons, France. Emerging Infectious Diseases, 2012, 18 (6), pp.1031-1031. 10.3201/eid1806.110632. hal-02648629

HAL Id: hal-02648629

https://hal.inrae.fr/hal-02648629v1

Submitted on 29 May 2020

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Distributed under a Creative Commons CC BY 4.0 - Attribution - International License
for prion researchers to refer to the
normal nonpathogenic conformation
of prions as “cellular prion proteins”
(3). When these normal cellular prion
precursors convert to pathogenic
prion proteins, the transmissible
conformations are characterized by
β-pleated sheets rather than the normal
α-helix structure, and they do not elicit
an immune response (4).

Lawrence B. Schonberger
and Robert B. Schonberger

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L.B. Schonberger); and Yale University School of Medicine, New Haven, Connecticut, USA (R.B. Schonberger)

DOI: http://dx.doi.org/10.3201/eid1806.120271

References

1. Etymologia: prion. Emerg Infect Dis. 2012;18:157. http://dx.doi.org/10.3201/eid1801.ET1801

2. Prusiner SB. Novel proteinaceous infectious particles cause scrapie. Science. 1982;216:136-44. http://dx.doi.org/10.1126/science.6801762

3. Brown P, Cervenakova L. A lexicon (out of control). Lancet. 2005;365:122. http://dx.doi.org/10.1016/S0140-6736 (05)17700-9

4. Dorland's illustrated medical dictionary 2012, 32nd ed. Philadelphia: Elsevier Saunders; 2012. p. 1515.

Address for correspondence: Lawrence B. Schonberger, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A30, Atlanta, GA 30333, USA; email: lbs1@cdc.gov

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Hepatitis E Virus
Infection in
Sheltered Homeless
Persons, France

**To the Editor:** Kaba et al. (1) reported a seroprevalence of 11.6% for hepatitis E virus (HEV) among homeless persons in the city of Marseille, located in southern France, and a multivariate analysis suggested that injection drug use (IDU) was an independent risk factor for HEV transmission. We disagree with this reported finding.

We conducted a retrospective subanalysis of results from a multicenter therapeutic trial assessing HEV seroprevalence among HIV/hepatitis C co-infected patients in France (2). Serum samples from 84 IDU patients, enrolled during 2000–2002 were stored at –80°C. The mean ± SD age of the patients was 39 ± 4 years; 53 (63%) were men, 19 (23%) were born outside France, and 38 (45%) were living in southern France. HEV antibodies were tested with the same assay as that used by Kaba et al. (1), and HEV RNA was detected by using a real-time reverse transcription PCR amplifying open reading frame 3 (3). None of the patients had detectable IgM against HEV or HEV RNA. Test results for 3 (3.6%) patients were positive for HEV IgG. Two of them lived in southern France, resulting in a 5.3% (2/38) HEV prevalence for IDU patients living in this region, where HEV IgG prevalence for healthy blood donors has reportedly ranged from 9% to 16.6% (4).

The difference between our study,
which demonstrated low HEV IgG
prevalence in IDU patients, even in
southern France, and the results from
Kaba et al. (1) must be interpreted with
caution because there were several
epidemiologic differences between
the 2 populations. Moreover, there
is a risk for false-negative serologic
results for HIV patients because of
impaired immunity, and the predictive

value of serologic testing is probably
low because of the artificially low
HEV prevalence reported for this
population. Despite these limitations,
our study suggests that the high
prevalence of HEV infection among
homeless persons in southern France
was not influenced by IDU, but
reflected the general epidemiology of
HEV in this region.

Sylvie Larrat,
Stéphanie Gaillard,
Monique Baccard, Lionel Piroth,
Patrice Cacoub, Stanislas Pol,
Christian Perronne,
Fabrice Carrat and
Patrice Morand for the French
National Agency for Research
on AIDS and viral hepatitis
HC02 Ribavic Study Team

Author affiliation: University Hospital of
Michallon, Isère, Grenoble, France

DOI: http://dx.doi.org/10.3201/eid1806.110632

References

1. Kaba M, Brouqui P, Richet H, Badiaga S, Gallian P, Raoult D, et al. Hepatitis E virus infection in sheltered homeless persons, France. Emerg Infect Dis. 2010;16:1761-3.

2. Carrat F, Bani-Sadr F, Pol S, Rosenthal E, Lunel-Fabiani F, Benzekri A, et al. Pegylated interferon alfa-2b vs standard interferon alfa-2b, plus ribavirin, for chronic hepatitis C in HIV-infected patients: a randomized controlled trial. JAMA. 2004;292:2839-48. http://dx.doi.org/10.1001/jama.292.23.2839

3. Jothikumar N, Cromeans TL, Robertson BH, Meng XJ, Hill VR. A broadly reactive one-step real-time RT-PCR assay for rapid and sensitive detection of hepatitis E virus. J Virol Methods. 2006;131:65-71. http://dx.doi.org/10.1016/j.jviromet.2005.07.004

4. Mansuy JM, Legrand-Abravanel F, Calot JP, Peron JM, Alric L, Agudo S, et al. High prevalence of anti-hepatitis E virus antibodies in blood donors from south west France. J Med Virol. 2008;80:289-93. http://dx.doi.org/10.1002/jmv.21056

Address for correspondence: Sylvie Larrat, Laboratoire de Virologie, Département des Agents Infectieux, CHU de Grenoble BP 2170 Grenoble Cedex 9 38043, France; email: slarrat@chu-grenoble.fr
**In Response:** The letter of Larrat et al. (1) raises interesting questions, but we disagree with the authors' conclusion. Their study and ours investigated the seroprevalence of infection with hepatitis E virus (HEV) (1,2); however, the 2 studies examined different populations. We studied homeless persons, for whom analysis of risk factors associated with HEV infection emphasized injection drug use (2). This represented independent data: injection drug use was a behavior associated with increased anti-HEV prevalence; a causal relationship between injection drug use and hepatitis E was not inferred. In contrast to our study population, the population studied by Larrat et al. comprised patients who were co-infected with HIV and hepatitis C virus and who reported injection drug use as the route of HIV or hepatitis C virus transmission: a distinctly different population from homeless persons (1). It is likely that behavior of HIV-positive and HIV-negative intravenous drug users is not the same. Moreover, late seroconversion, persistent seronegativity, and seroreversion of

IgG against HEV have been reported for severely immunocompromized patients, including some infected with HIV (3–5), which brings up the question as to whether prevalence of IgG against HEV is underestimated among severely immunocompromised persons infected with HIV.

Seroprevalence studies of different populations, especially those with differing immune responses, cannot lead except by chance to the same result. Of note, we recently reported that HEV seroprevalence was 2.3% among injection drug users infected with HIV (5).

Mamadou Kaba
and Philippe Colson

Author affiliations: Timone University Hospital, Marseille, France; and University of the Mediterranean (Aix-Marseille-II), Marseille

DOI: http://dx.doi.org/10.3201/eid1806.111412

References

1. Larrat S, Gaillard S, Baccard M, Piroth L, Cacoub P, Pol S, et al. Hepatitis E virus infection in sheltered homeless persons, France [letter]. Emerg Infect Dis. 2012;18:1031.

2. Kaba M, Brouqui P, Richet H, Badiaga S, Gallian P, Raoult D, et al. Hepatitis E virus infection in sheltered homeless persons, France. Emerg Infect Dis. 2010;16:1761–3.

3. Dalton HR, Bendall RP, Keane FE, Tedder RS, Ijaz S. Persistent carriage of hepatitis E virus in patients with HIV infection. N Engl J Med. 2009;361:1025–7. http://dx.doi.org/10.1056/NEJMc0903778

4. Kenfak-Foguena A, Schöni-Affolt er F, Bürgisser P, Witteck A, Darling KEA, Kovari H, et al. Swiss HIV Cohort Study. Hepatitis E virus seroprevalence and chronic infections in patients with HIV, Switzerland. Emerg Infect Dis. 2011;17:1074–8. http://dx.doi. org/10.3201/eid1706.101067

5. Kaba M, Richet H, Ravaux I, Moreau J, Poizot-Martin I, Motte A, et al. Hepatitis E virus infection in patients infected with the human immunodeficiency virus. J Med Virol. 2011;83:1704–16. http://dx.doi.org/10.1002/jmv.22177

Address for correspondence: Philippe Colson, Pôle des Maladies Infectieuses et Tropicales Cliniques et Biologiques, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, 264 Rue Saint-Pierre, 13385 Marseille CEDEX 05, France; email: philippe.colson@ap-hm.fr

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