Hepatitis E: A Literature Review

Abstract

Hepatitis E is the fifth known form of human viral hepatitis. Although not very common in our clinical practice, the incidence in Western countries is increasing. Infection with the hepatitis E virus (HEV) may be related to acute illness, liver failure, chronic hepatitis and cirrhosis. HEV itself is an RNA virus, with eight described genotypes (HEV 1–8), four of which more commonly affect humans and have, thus, been better studied. Besides liver manifestations, genotype 3 is also related to extra-hepatic manifestations, such as neurological, renal and rheumatological. Evolution to chronic disease occurs especially in patients who underwent transplantation, have hematological malignancies requiring chemotherapy, or have infection with the human immunodeficiency virus. The diagnosis may be difficult because of the low availability of tests and due to low sensibility and specificity. The acute form of illness does not have to be treated, but the chronic one does. We present here a literature review of hepatitis E and the relation between chronic hepatitis E and transplantation.

Hepatitis E virus genotype 3 is a common finding in liver‐transplanted patients undergoing liver biopsy for elevated liver enzymes with a low De Ritis ratio and suspected acute rejection: A real‐world cohort

“…The course and clinical presentation of hepatitis E are highly variable . Interestingly, a low De Ritis ratio (median: 0.4137) was found in all five patients with HEV infection, while patients without infection showed a higher ratio (median: 1.0875; P = 0.021).…”

Prevalence of active hepatitis E virus infection and efficacy of ribavirin treatment in renal allograft recipients

“…In the present study, a rapid virological response with HEV elimination within first 4 weeks of ribavirin therapy was documented for the majority of patients (63%), thus, potentially contributing to the high rate of SVR. As spontaneous clearance of HEV in solid organ transplant patients is very unlikely and all patients already had abnormalities of liver function, we initiated ribavirin therapy early in order to avoid chronicity of HEV infection and to reduce the risk for development of liver cirrhosis and extrahepatic manifestations . We can only speculate that this may also have contributed to the high SVR rates.…”

“…In most cases, hepatitis E virus (HEV) infection is asymptomatic and only rarely causes acute liver failure in an immunocompetent host . However, immunocompromised patients are at increased risk to develop chronic HEV infection that can rapidly evolve to liver cirrhosis or in rare instances manifest itself extrahepatically . In developed countries, HEV infection is related to genotype (GT) 3, which is of zoonotic origin .…”

First detection of Hepatitis E virus (Orthohepevirus C) in wild brown rats (Rattus norvegicus) from Great Britain

“…Hepatitis E virus (HEV) is a leading cause of viral hepatitis globally, causing an estimated three million cases of acute hepatitis and 70,000 deaths annually (de Guerra, Kampa, Morsoletto, Junior, & Ivantes, 2017). While most infections are probably self-limiting and subclinical, infection can lead to liver failure, chronic hepatitis and cirrhosis with a higher mortality rate among pregnant women and the immunocompromised (Guerra et al, 2017).…”