HIV and GI Tract Complications by Lisa M. Chirch & Jurate Ivanaviciene

Author:Lisa M. Chirch & Jurate Ivanaviciene
Language: eng
Format: epub
ISBN: 9783030133771
Publisher: Springer International Publishing

Pathogenesis

The exact pathogenic mechanisms of HEV are incompletely understood. While it is generally accepted that viral replication occurs in hepatocytes, there is evidence of extrahepatic HEV viral replication, although no definitive evidence of viral replication within intestine (as in HAV infection) [37]. Studies of the cellular immune response in HEV infection suggest that specific host factors, as opposed to virus genotype or variants, are the most important factor in the pathogenesis of hepatitis [38]. CD8+ T cells have been shown to infiltrate the liver in fulminant hepatitis, and infected patients have been found to have more CD8+ T cells in peripheral blood than healthy controls, suggesting a pathogenic importance [39, 40]. Notably for PLWH, hepatitis E can persist as a chronic infection, a finding best described in the solid organ transplant population but also observed in PLWH with low peripheral CD4+ T-cell counts, again suggesting an impaired cellular immune response as the driving pathogenic mechanism [41, 42].

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