Similarities, differences, and possible interactions between hepatitis E and hepatitis C viruses: Relevance for research and clinical practice

Table 2 Research perspectives for the next future

No.	Research perspectives for the next future
1	In vitro and in vivo studies to define pathogenic interactions during HEV/HCV coinfection. Cell lines model could explain interactions between viral proteins and cellular pathway responsible for liver fibrosis progression, liver steatosis and insulin resistance encountered in patients
2	Studies to understand relationships among immune phenomena (autoantibodies, cryoglobulins and autoimmune diseases) in patients infected by both viruses, and their correlated in terms of T- and B-cell responses and human leukocyte antigen type
3	Clinical trials to test safety and effectiveness of DAA in co-infected patients and new therapies. At present, data on DAA treatment is limited to in vitro studies or very few case reports
4	In vitro studies to evaluate genetic interactions between HEV and HCV during viral replication. Permissive cell lines, infected simultaneously by the two viruses, could show whether there is an interference or synergy between them during viral progeny production

DAA: Directly acting antivirals; HEV: Hepatitis E virus; HCV: Hepatitis C virus.