Treatment of hepatitis E virus.
Over the last 10 years, it has become apparent that hepatitis E virus (HEV) is a pathogen of global significance. In contrast to HEV in the developing world, HEV in developed countries is caused by HEV genotypes 3 and 4, which are enzoonotic with a porcine primary host and cause both acute and chronic infection. Chronic infection occurs in the immunosuppressed, including transplant recipients, and untreated can cause rapidly progressive cirrhosis.



Ribavirin has been used successfully to treat acute hepatitis E in high-risk patients. Ribavirin monotherapy is the treatment of choice for patients chronically infected with HEV, with sustained virological response (SVR) of approximately 85%. A minority of chronically infected patients fail to achieve SVR with ribavirin monotherapy, possibly because of viral mutants. The treatment of patients who fail to achieve SVR with ribavirin monotherapy is problematic.



Ribavirin is an effective treatment for hepatitis E, but further studies are required to determine which other antiviral agents are of clinical utility in treating HEV in the minority of patients who do not respond to ribavirin.
aRoyal Cornwall Hospital; European Centre for Environment and Human Health, University of Exeter, Truro, UK bDepartments of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France.
Harry R
HR
Dalton
Nassim
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Kamar
D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use*; D005838:Genotype; D016751:Hepatitis E / Q000188:drug therapy*; D016752:Hepatitis E virus / Q000235:genetics; D006801:Humans; D016867:Immunocompromised Host; D012254:Ribavirin / Q000627:therapeutic use*; D013552:Swine
D000998:Antiviral Agents; D012254:Ribavirin