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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Hepatitis E medical therapy

Introduction

Overview

Overview

Immunocompetent patients usually do not require any medical therapy. However, patients with pre-existing liver disease, particularly transplanted patients on immunosuppressive therapy, often develop chronic infection and require antiviral therapy. Antiviral therapy may include either Ribavirin monotherapy (first-line), Pegylated interferon-α monotherapy, or a combination of both.

Medical Therapy

Medical Therapy

As no specific therapy is capable of altering the course of acute hepatitis E infection, prevention is the most effective approach against the disease. Hospitalization is required for fulminant hepatitis and should be considered for infected pregnant women.[1][2][3]

Acute Hepatitis E

The majority of hepatitis E cases in immunocompetent patients are self-limited. Some patients may require symptomatic treatment, however, HEV infection resolves spontaneously in most cases.[4]

Patients with pre-existing liver conditions, may require treatment with ribavirin. A patient who received treatment with ribavirin showed a normalization of bilirubin levels and a decrease in transaminases.[5][6]

Pregnant women with hepatitis E should be treated, however, a specific treatment regimen has not been established. Ribavirin might be indicated for the treatment of these patients. Despite the teratogenic contra-indications of ribavirin, the risks of HEV infection for the mother and fetus may outweigh the teratogenicity risks of the drug.[7]

Chronic Hepatitis E

Chronic HEV infection often occurs in transplanted patients. In this group of patients, viral clearance is the ideal therapeutic target. Three treatment options are available:

Due to the lack of evidence regarding the treatment of chronic hepatitis E, this should be individualized for each patient, according to:

Assessment of a potential reduction of the immunosuppressive therapy, particularly of the T-cell suppression, is the initial approach to treat these patients. 30 % of cases in whom this approach is possible, are cleared from HEV.[8][9]

Patients for whom a reduction of immunosuppression is not possible, and for those who fail to respond to this reduction, antiviral therapy should be considered.[7] This may include pegylated interferon-α monotherapy; ribavirin monotherapy; or a combination of both.[8][10][11][12]

Antiviral Therapy
Drug Characteristics
Ribavirin Monotherapy
  • First treatment option for patients with chronic hepatitis E
  • HEV is often cleared after a few weeks of ribavirin monotherapy
  • Usually prescribed: 600 – 1000 mg/day, during 3 months, however, it must be adjusted to the patient’s renal function in order to avoid hemolytic anemia induced by the drug[7]
Pegylated Interferon-α Monotherapy
  • Must be used with caution since it increases the risk of rejection in kidney transplanted patients
  • The duration of treatment may range from 3 to 12 months
  • Due to its severe side-effects and potential organ rejection, it is not indicated in heart or kidney-tranplanted patients
References

References

  1. ↑ “Hepatitis E” (PDF).
  2. ↑ Fields, Bernard (2013). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781451105636.
  3. ↑ LastName, FirstName (2011). Lippincott’s guide to infectious diseases. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. ISBN 1605479756.
  4. ↑ Wedemeyer H, Pischke S, Manns MP (2012). “Pathogenesis and treatment of hepatitis e virus infection”. Gastroenterology. 142 (6): 1388–1397.e1. doi:10.1053/j.gastro.2012.02.014. PMID 22537448.
  5. ↑ Péron JM, Dalton H, Izopet J, Kamar N (2011). “Acute autochthonous hepatitis E in western patients with underlying chronic liver disease: a role for ribavirin?”. J Hepatol. 54 (6): 1323–4, author reply 1324-5. doi:10.1016/j.jhep.2011.01.009. PMID 21281681.
  6. ↑ Gerolami R, Borentain P, Raissouni F, Motte A, Solas C, Colson P (2011). “Treatment of severe acute hepatitis E by ribavirin”. J Clin Virol. 52 (1): 60–2. doi:10.1016/j.jcv.2011.06.004. PMID 21764632.
  7. ↑ 7.0 7.1 7.2 Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J; et al. (2012). “Hepatitis E.” Lancet. 379 (9835): 2477–88. doi:10.1016/S0140-6736(11)61849-7. PMID 22549046.
  8. ↑ 8.0 8.1 Kamar N, Rostaing L, Abravanel F, Garrouste C, Lhomme S, Esposito L; et al. (2010). “Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection”. Gastroenterology. 139 (5): 1612–8. doi:10.1053/j.gastro.2010.08.002. PMID 20708006.
  9. ↑ Kamar N, Abravanel F, Selves J, Garrouste C, Esposito L, Lavayssière L; et al. (2010). “Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation”. Transplantation. 89 (3): 353–60. doi:10.1097/TP.0b013e3181c4096c. PMID 20145528.
  10. ↑ Kamar N, Rostaing L, Abravanel F, Garrouste C, Esposito L, Cardeau-Desangles I; et al. (2010). “Pegylated interferon-alpha for treating chronic hepatitis E virus infection after liver transplantation”. Clin Infect Dis. 50 (5): e30–3. doi:10.1086/650488. PMID 20113176.
  11. ↑ Haagsma EB, Riezebos-Brilman A, van den Berg AP, Porte RJ, Niesters HG (2010). “Treatment of chronic hepatitis E in liver transplant recipients with pegylated interferon alpha-2b”. Liver Transpl. 16 (4): 474–7. doi:10.1002/lt.22014. PMID 20373458.
  12. ↑ Dalton HR, Keane FE, Bendall R, Mathew J, Ijaz S (2011). “Treatment of chronic hepatitis E in a patient with HIV infection”. Ann Intern Med. 155 (7): 479–80. doi:10.7326/0003-4819-155-7-201110040-00017. PMID 21969351.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]