Chronic hepatitis E: a review of the literature

Abstract

In 1978, the first case of hepatitis E was identified as non-A, non-B hepatitis. Hepatitis E virus (HEV) infection is believed to be one of the common causes of enterically transmitted acute hepatitis in developing countries and is rare in developed countries, except in patients with a history of travel. However, an increasing number of chronic HEV infection cases have recently been reported in developed countries. In these countries, immunosuppressed patients with HEV infection, such as organ transplant recipients, human immunodeficiency virus (HIV)-infected patients or patients with haematological malignancies, could develop chronic hepatitis E (CHE) infection. Approximately 60% of HEV infections in immunocompromised patients after solid organ transplantation evolve to CHE without antiviral treatment. Clinical manifestations of CHE are often nonspecific symptoms. Many patients with CHE infection are asymptomatic, but some have jaundice, fatigue, abdominal pain, fever and asthenia. Several extrahepatic manifestations have also been reported. Although chronic HEV infection can result in progressive severe liver failure and cirrhosis, diagnosis is often controversial because of the lack of specific diagnostic criteria. Many CHE cases are diagnosed by HEV RNA-positive serum or stool for >6 months. Immunosuppressive drugs, interferon-alpha and ribavirin have been used for treatment. Diagnostic reverse-transcription polymerase chain reaction is useful for estimating treatment efficacy. Preventive measures for HEV infection have been discussed, while systematic guidelines have not yet been reported.

Antiviral Activities of Different Interferon Types and Subtypes against Hepatitis E Virus Replication

“…While genotypes 1 and 2 solely infect humans, genotypes 3 and 4 are zoonotic pathogens with major virus reservoirs in pigs, wild boars, and deer (3,4). HEV genotype 3 infections in humans can be associated with prolonged viremia, leading to chronic infection in immunocompromised patients such as organ transplant recipients, patients with HIV infection, or patients with hematological malignancies (5). Treatment options for chronically infected patients include either ribavirin (RBV) for at least 3 months or pegylated alpha 2a/alpha 2b interferon (IFN-␣2a/␣2b) which, however, can be associated with severe side effects and can cause graft rejection (6).…”

Sero - Epidemiology of Hepatitis E and D Infections among HIV - Infected and HIV/HCV - Coinfected Patients in Jahrom, Southern Iran

“…Prevalence and progression to chronicity of HEV and HIV infections could be higher than what is expected (12) Copyright © 2018, Archives of Clinical Infectious Diseases. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited and that this condition is was happened in high risk individuals (13).…”

Prevalence of Hepatitis E Virus Antibodies Among Blood Donors: A Systematic Review and Meta-Analysis

“…In addition, the detection of anti-HEV IgG antibodies provides the evidence of recent or remote exposure to HEV. In this way, both antibodies are important for the HEV infection diagnosis and can be asso-ciated with a permanent infection (17,18).…”

“…Chronic cases are also uncommon, but may occur specially in immunosuppressed patients (15,16). There are many laboratory tests for HEV infection diagnosis, which can be classified into direct (detection of HEV or viral protein by the polymerase chain reaction or enzyme immunoassay) and indirect methods (detection of anti-HEV antibodies) (17,18).…”