Hepatitis E: Discovery, global impact, control and cure

Table 3 Effect of drugs on hepatitis E virus replication and their use and impact on immunosuppressant therapy during chronic hepatitis E virus infection in solid organ transplant patients

Class	Drug	Effect on HEV replication	Clinical use
Calcineurin inhibitors	Cyclosporine, tacrolimus	Stimulates HEV replication with increase in HEV load and promotes HEV persistence	Reduce dose
mTOR inhibitors	Rapamycin, everolimus	Stimulates HEV replication with increase in HEV load	Reduce dose
Antimetabolite immunosuppressant	Mycophenolate mofetil	Inhibits HEV replication and helps HEV clearance	Continue the drug
Guanosine analog	Ribavirin	Inhibits HEV replication and causes HEV clearance	Primary drug for therapy
Cytokines	Pegylated interferon α	Inhibits HEV replication and causes HEV clearance	Indicated if Ribavirin therapy fails
Nucleotide analog	Sofosbuvir	Inhibits HEV replication in vitro	Unclear, clinical trials indicated

HEV: Hepatitis E virus.