title: Treatment of autochthonous acute hepatitis E with short-term ribavirin: a multicenter retrospective study.
abstract: OBJECTIVE
  Hepatitis E virus (HEV) genotypes 3 and 4 cause sporadic cases of infection in developed countries. Being elderly and having an underlying liver disease are the main risk factors for death in this population. Chronic infection has been described in immunocompromised patients. Ribavirin is now the antiviral treatment of choice in solid-organ-transplant recipients with chronic HEV infection. We hypothesized that early short-term treatment of acute HEV infection may be useful for patients with risk factors or undergoing chemotherapy.
  
  
  METHODS
  Between July 2010 and January 2014, 21 patients diagnosed with acute HEV infection were treated with ribavirin, at 600-800 mg/day for up to 3 months. All serum samples were positive for HEV RNA.
  
  
  RESULTS
  Nine patients were treated for severe hepatitis. Six patients were aged >70 years. Four patients were receiving an immunosuppressive therapy for an autoimmune disease and two patients were undergoing chemotherapy for a malignancy. Two patients received a fixed-dose regimen. For all other patients, ribavirin was stopped when HEV became undetectable in the serum. The median duration of ribavirin treatment was 26 days. Two patients developed severe anaemia. Two patients with encephalopathy died. One patient relapsed transiently. All patients were cleared of HEV and regained normalized liver-enzyme levels. Immunosuppressive treatment and chemotherapy could be resumed.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Péron
authors.affiliation: Laboratoire de Virologie, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, INSERM, UMR 1043, Centre de Physiopathologie de Toulouse, Toulouse, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Abravanel
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.|INSERM U1048, Institute of Metabolic and Cardiovascular Diseases I2MC, Université Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Maeva
authors.initials: M
authors.lastname: Guillaume
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital de la Conception, Centre Hospitalier Universitaire de Marseille, Université de Marseille, Marseille, France.
authors.forename: René
authors.initials: R
authors.lastname: Gérolami
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Nana
authors.affiliation: Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire de Nice, Université de Nice-Sophia-Antipolis, INSERM U1065, Nice, France.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Anty
authors.affiliation: Service d'Hépato-gastroentérologie, Centre Hospitalier de Pau, Pau, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pariente
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital de Hyères, Hyères, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Renou
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Marie-Angèle
authors.initials: MA
authors.lastname: Robic
authors.affiliation: Service de Médecine Interne, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Alric
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Vinel
authors.affiliation: Laboratoire de Virologie, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, INSERM, UMR 1043, Centre de Physiopathologie de Toulouse, Toulouse, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
authors.affiliation: Service de Néphrologie et transplantation d'organes, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, INSERM, UMR 1043, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D005838:Genotype; D016751:Hepatitis E / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D016752:Hepatitis E virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012074:Remission Induction; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D012254:Ribavirin
keywords: acute hepatitis; antiviral therapy; cirrhosis; hepatitis E; immunodeficiency