Hepatitis E: a concise review of virology, epidemiology, clinical presentation and therapy

M.C. Donnelly, L. Scobie, C.L. Crossan, H. Dalton, P.C. Hayes, K. J. Simpson

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Abstract

Background
Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure.

Aim
To detail current understanding of the molecular biology of HEV, diagnostic and therapeutic strategies and propose future directions for basic science and clinical research.

Methods
PubMed was searched for English language articles using the key words “hepatitis E”, “viral hepatitis”, “autochthonous infection”, “antiviral therapy”, “liver transplantation”, “acute”, “chronic”, “HEV”, “genotype”, “transmission” “food-borne”, “transfusion”. Additional relevant publications were identified from article reference lists.

Results
There has been increasing recognition of autochthonous HEV infection in Western countries, mainly associated with genotype 3. Chronic HEV infection has been recognised since 2008, and in transplant recipients this may lead to cirrhosis and organ failure. Modes of transmission include food-borne transmission, transfusion of blood products and solid organ transplantation. Ribavirin therapy is used to treat patients with chronic HEV infection, but new therapies are required as there have been reports of treatment failure with ribavirin.

Conclusions
Autochthonous HEV infection is a clinical issue with increasing burden. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.
Original languageEnglish
Pages (from-to)126-141
Number of pages16
JournalAlimentary Pharmacology and Therapeutics
Volume46
Issue number2
Early online date27 Apr 2017
DOIs
Publication statusPublished - Jul 2017

Keywords

  • hepatitis E virus
  • epidemiology
  • review article
  • virology

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