A Review of the Diagnosis and Management of Hepatitis E

Abstract

Purpose of review We aim to provide the readers an up-to-date knowledge of the structure, epidemiology, and transmission followed by a detailed discussion on testing, diagnostics and management of hepatitis E virus infection. We have also included a comprehensive review of hepatitis E in pregnancy. Recent findings European Association for the Study of the Liver established clinical practice guidelines for testing and treatment of suspected hepatitis E virus infections in 2018. Evidence suggests chronic hepatitis E may follow a course similar to hepatitis B/C with progression to cirrhosis and possibly hepatocellular carcinoma in immunocompromised patients. Summary Hepatitis E virus is the most common cause of acute viral hepatitis worldwide. A combination of serology and nucleic acid amplification testing is the recommended strategy for suspected patients. Ribavirin therapy for a period of 3 months is the drug of choice for severe acute hepatitis, acute-on chronic liver failure, and chronic infections from hepatitis E virus in immunocompromised patients who are unresponsive to decreased immunosuppression. PEGylated interferon α can be used for ribavirin-resistant liver transplant patients with chronic hepatitis E. Further research in therapeutic options is essential considering the stormy course of hepatitis E infection during pregnancy and teratogenicity of all available options.

Towards the Improved Accuracy of Hepatitis E Diagnosis in Vulnerable and Target Groups: A Global Perspective on the Current State of Knowledge and the Implications for Practice

“…These are methyltransferase (MET), X domain, helicase (Hel), and RNA-dependent RNA polymerase (RdRp). The function of other domains such as the Y domain, papain-like cysteine protease (PCP), and hypervariable region (HVR) is still undetermined [ 16 , 17 ].…”

“…ORF2 encodes for the capsid protein and has its role in HEV infection diagnostics and vaccine development. It is a 72 kDa protein that is N-glycosylated in mammalian cells [ 17 , 18 ].…”

“…The first HEV epidemic (1955–1956) infected 29,300 people in India [ 14 , 35 , 36 ]. In hyperendemic regions of the world, the infection is caused by HEV genotypes 1 and 2, most often in young adults, and extremely severe forms develop in pregnant women [ 17 , 37 , 38 ].…”

“…Genotype 1 causes infections in Asia (south, southeast, and central) and North Africa [ 17 , 39 ]. Furthermore, the presence of the HEV-1 genotype was observed in Cuba and Venezuela [ 32 ].…”

“…It is estimated that HEV infections caused 70,000 deaths due to acute liver failure and about 3000 stillbirths [ 17 ]. China is considered an endemic HEV region [ 46 ].…”