No evidence of sexual transmission of HEV among individuals using HIV pre‐exposure prophylaxis

We investigated the seroprevalence and incidence of hepatitis E virus (HEV) infection in men who have sex with men (MSM) who have been exposed to pre‐exposure prophylaxis (PrEP) against HIV as sexual transmission of HEV has been suggested. A total of 147 PrEP‐using MSM and 147 blood donors matched for sex, age and geographical area were tested for anti‐HEV IgG and IgM. Among them, 135 have been followed for 1 year, at the end of which serological tests for HEV were performed retrospectively on stored samples. Laboratory data on sexual transmitted infections (STIs) and viral hepatitis, including hepatitis A virus (HAV), were collected. Baseline seroprevalence rates in PrEP users were 42.2% (anti‐HEV IgG) and 3.4% (anti‐HEV IgM). Those of the control blood donors were similar (anti‐HEV IgG 43.5% and anti‐HEV IgM 4.1%). There was no incident of HEV infection despite the rates of bacterial STIs (incidence rate (IR) = 46.6%) and HAV infection (IR = 15.8%). Age was the only risk factor associated with anti‐HEV IgG seropositivity at baseline and at the end of follow‐up. Sexual transmission does not seem to be a major route of HEV infection in MSM, unlike HAV.