Extrahepatic hepatitis E virus in cerebrospinal fluid of people living with human immunodeficiency virus at an Academic Hospital, South Africa

Background Hepatitis E virus (HEV) continues to cause global health problems and has the potential to cause extrahepatic manifestations. The purpose of the study was to investigate extrahepatic HEV in stored cerebrospinal fluid (CSF) from people living with HIV (PLWHIV). Methods In this cross-sectional study, 54 CSF specimen samples of PLWHIV and past medical history of neurological disorders were screened for HEV at an academic hospital in South Africa. CSF specimens were subjected to RNA isolation and in-house PCR amplification. HEV amplicons were sequenced for genotyping and descriptive statistical analysis was used to analyze the study data. Results All 54 CSF samples came from the Black African ethnic group. PCR amplification of HEV RNA was successful in 61% (33/54) of the samples, with 52% (17/33) being from females. No statistical significance variations were observed for sex (p = 0.7) between HEV RNA positive and negative. The median age was 34 years (IQR: 21, 28 - 49) with no statistical significance variation in age group (p = 0.7). The median for the CD4+ T-cells count was 306 cells/µL (IQR: 476, 62 - 538), with 127 cells/µL (IQR: 31 - 465) among the 13 HEV RNA positive and 436 (IQR: 244 - 664) among 20 HEV negative and with no significant statistical variation (p = 0.087). A total of 11 nucleotide sequences demonstrated similarity to HEV genotype 3 (HEV Gt-3), previously isolated from swine in Canada, Italy and Japan, as well as from humans in Japan, Switzerland and France. Conclusions This is the first study to report extrahepatic HEV in the CSF of PLWHIV in South Africa with a past clinical history of neurologic symptoms. The findings give preliminary evidence and knowledge of circulating HEV genotype 3 with possible zoonotic transmission in our region, necessitating the enhanced molecular screening to improve diagnosis and management of HEV.