Treatment of autochthonous acute hepatitis E with short‐term ribavirin: a multicenter retrospective study

Péron, Jean Marie; Abravanel, Florence; Guillaume, Maéva; Gerolami, René; Nana, Jean; Anty, Rodolphe; Pariente, Alexandre; Renou, Christophe; Bureau, Christophe; Robic, Marie‐Angèle; Alric, Laurent; Vinel, Jean Pierre; Izopet, Jacques; Kamar, Nassim

doi:10.1111/liv.12911

Cited by 61 publications

(50 citation statements)

References 16 publications

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“…Patients with acute hepatitis E and underlying chronic liver disease have a poor prognosis, and a small number of such patients have been treated successfully with ribavirin [34] . Patients with chronic infection (defined as persisting viremia >3 months) should be treated.…”

Section: Detection Prevention and Treatment Of Hepatitis Ementioning

confidence: 99%

“…Those who present late will often display patterns of liver enzyme derangement indistinguishable from those seen in other causes of acute-on-chronic liver failure [32] . Early intervention with ribavirin has been shown to have efficacy in treating these patients [34] , and so routine testing for HEV should be considered for all individuals presenting with decompensated chronic liver disease.…”

Section: Acute Infectionmentioning

confidence: 99%

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Hepatitis E Virus: Time to Change the Textbooks

Dalton

Webb

Norton

et al. 2016

Dig Dis

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Until recently, hepatitis E virus (HEV) was thought not to occur in developed countries. It is now clear that locally acquired HEV is common in such settings. HEV infection acquired in these areas differs from that in developing countries in a number of important aspects: it is caused by genotype 3 (and 4 in China and Japan), it mainly affects middle-aged/elderly males and it is zoonotic with a porcine primary host. Pig herds worldwide are infected with HEV genotype 3 and HEV has been found in the human food chain in a number of developed countries. However, the route of transmission is not fully understood, since most cases are not obviously associated with pigs/pig products. HEV can be transmitted by blood transfusion and surprisingly high numbers of asymptomatic blood donors are viremic at the time of donation: Germany 1:1,200, Netherlands 1:2,671, England 1:2,848. Our understanding of the clinical phenotype of HEV infection in humans has undergone a sea-change in recent years. Previously, HEV was thought to cause only acute self-limiting hepatitis. However, HEV may cause persistent disease in the immunocompromised. Patients with chronic HEV infection have no symptoms, but some develop rapidly progressive liver cirrhosis. The full clinical spectrum of HEV is still emerging. HEV has important extra-hepatic manifestations, which deserve further investigation. For example, HEV can cause a wide range of neurological illness. In particular, very recent data suggest that Guillain-Barré syndrome and neuralgic amyotrophy are associated with locally acquired HEV in approximately 5 and 10% of the cases, respectively.

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Section: Detection Prevention and Treatment Of Hepatitis Ementioning

confidence: 99%

Section: Acute Infectionmentioning

confidence: 99%

Hepatitis E Virus: Time to Change the Textbooks

Dalton

Webb

Norton

et al. 2016

Dig Dis

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“…In contrast, autochthonous HEV infection usually presents with a milder course of disease (7) and is only sporadically reported as the cause of decompensation and ACLF in large Western cohorts (19). A retrospective cohort of patients treated with ribavirin for autochthonous HEV infection revealed that mortality occurred only in patients with acute decompensation of underlying cirrhosis (20). It cannot be excluded that other hepatic or extrahepatic factors might have contributed to the decompensation of cirrhosis in the current study patient (21).…”

mentioning

confidence: 86%

“…It remains elusive whether treatment with ribavirin would have ameliorated the course of ACLF and prevented acute pancreatitis as an extrahepatic manifestation. However, the severe course of HEV infection in elderly patients with underlying liver disease evidence supports the early use of ribavirin in patients at risk (20).…”

Section: Aclf Gradementioning

confidence: 99%

Acute-on-Chronic Liver Failure with Complicating Pancreatitis After Autochthonous Hepatitis E Infection

et al. 2017

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Hepatitis E virus infection (HEV) is the most common cause of acute viral hepatitis in the world. Genotypes 1 and 2 are responsible for large outbreaks and sporadic cases in the developing countries, whereas genotypes 3 and 4 are zoonotic infections and cause sporadic autochthonous disease with usually mild course in the immunocompetent host without preexisting liver damage. Acute pancreatitis is acknowledged as an extrahepatic complication of acute viral hepatitis, most often related to acute hepatitis A to C. More than 50 cases of HEV-associated acute pancreatitis are reported from South Asia where HEV genotype 1 prevails. The current study reports the case of an 85-year-old male with autochthonous acute HEV infection, which progressed into acute-on-chronic liver failure (ACLF) and was complicated by severe acute pancreatitis. This case underlines autochthonous HEV infection as a cause of multiple organ failure in patients with pre-existing liver disease and suggests an association with acute pancreatitis. Clinicians should be aware of life-threatening complications of autochthonous HEV infection, especially in patients with cirrhosis.

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“…A few patients who have presented with severe acute HEV infection, or acute or chronic hepatitis, have been given ribavirin [40,41]. A rapid decrease in HEV RNA concentration has been obtained and HEV clearance achieved.…”

Section: Treatment Of Hev Infection With Additional Complicationsmentioning

confidence: 99%

Treatment of HEV Infection in Patients with a Solid-Organ Transplant and Chronic Hepatitis

Kamar

Lhomme

Abravanel

et al. 2016

Viruses

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Treatment of autochthonous acute hepatitis E with short‐term ribavirin: a multicenter retrospective study

Abstract: Treatment of acute HEV infection using ribavirin seems safe and effective. Short-term treatment tailored to viraemia may be the best regimen for this indication.

Cited by 61 publications

References 16 publications

Hepatitis E Virus: Time to Change the Textbooks

Hepatitis E Virus: Time to Change the Textbooks

Acute-on-Chronic Liver Failure with Complicating Pancreatitis After Autochthonous Hepatitis E Infection

Treatment of HEV Infection in Patients with a Solid-Organ Transplant and Chronic Hepatitis

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