title: Chronic Hepatitis E Viral Infection After Liver Transplantation: A Regression of Fibrosis After Antiviral Therapy.
abstract: Hepatitis E virus (HEV) infection is increasingly being reported in immunocompromised patients and particularly organ transplant recipients. In this context, HEV infection frequently evolves to chronic infection with a rapid progression of fibrosis to cirrhosis. Ribavirin monotherapy and a minimization of immunosuppression represent the treatment of choice, with a good response rate. However, no data are available on whether treatment can achieve a regression of liver fibrosis in chronic HEV patients. A 57-year-old male patient received a liver transplant for alcoholic cirrhosis and, 6 years later, developed biopsy-proven chronic HEV infection. The patient received different antiviral therapy regimens (pegylated interferon alpha 2b and ribavirin different dosages, and long-term treatment with ribavirin monotherapy still ongoing) but without achieving a sustained virological response. Liver function parameters normalized after 1 month of treatment but without the clearance of HEV. Hepatitis E virus RNA levels also remained detectable in the serum and stools throughout ribavirin monotherapy. No serious adverse events were reported. A gradual regression of liver fibrosis was reported (Metavir A0/F1 in 2015 versus A3/F4 in 2008). Long-term treatment with ribavirin is safe in liver transplant recipients, without achieving HEV sustained virological response, and may induce a biopsy-proven regression of liver fibrosis in a liver transplant recipient with cirrhosis after chronic HEV infection.
authors.affiliation: 1 APHP, Hôpital Pitié-Salpêtrière, Unité Médicale de Transplantation Hépatique, Hépato-Gastro-Enterologie. Hôpital Pitié-Salpêtrière UPMC Paris VI, Boulevard de l'Hôpital, Paris, France. 2 Medicina Traslazionale, Università Piemonte Orientale Amedeo Avogrado, Italy. 3 APHP, Hôpital Pitié-Salpêtrière, Service d'Anatomie et Cytologie Pathologique, Paris, France. 4 APHP, Hôpital Pitié-Salpêtrière, Service d'Anesthésie-Réanimation, Paris, France. 5 APHP, Hôpital Saint Antoine, Service d'Anatomie et Cytologie Pathologique, Paris, France.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mazzola
authors.forename: Margherita
authors.initials: M
authors.lastname: Tran Minh
authors.forename: Frédéric
authors.initials: F
authors.lastname: Charlotte
authors.forename: Aisha
authors.initials: A
authors.lastname: Hdiji
authors.forename: Denis
authors.initials: D
authors.lastname: Bernard
authors.forename: Dominique
authors.initials: D
authors.lastname: Wendum
authors.forename: Yvon
authors.initials: Y
authors.lastname: Calmus
authors.forename: Filomena
authors.initials: F
authors.lastname: Conti
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D004359:Drug Therapy, Combination; D016751:Hepatitis E / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006521:Hepatitis, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D012074:Remission Induction; D000072230:Sustained Virologic Response; D013812:Therapeutics; D013997:Time Factors; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents