Hepatitis E virus infection: Epidemiology and treatment implications

Table 3 Treatment of chronic hepatitis E virus with ribavirin regimen

Ref.	Type of study	Patient profile	Ribavirin regimen	Result	Adverse effects
Kamar et al[99]	Prospective case series	6 kidney transplant recipients, HEV RNA (+) for median of 36.5 mo	600-800 mg/d for 3 mo adapted to GFR, Hgb	SVR in 4/6 patients; relapse in 2/6; AST, ALT normalized all	Anemia led to blood transfusion and RBV dose reduction in 2/6 patients
Mallet et al[105]	Case report	A kidney and pancreas transplanted man, a women with idiopathic CD4+ T lymphocytopenia	12 mg/kg daily for 12 wk	Both cleared HEV after 4 wk of treatment and remained undetectable, LFT normalized	Anemia in 1st patient led to Ribavirin dose reduction to 200 mg/d
Pischke et al[96]	Prospective case series	Organ transplant recipients 11 subjects	600-1000 mg/d for 5 mo, dose reduction according to Hgb or anemia	9/11 showed SVR	Anemia, the mean Hgb decline was 3.4 g/dL (range 0-7.9 g/dL)
Neukam et al[106]	Case report	2 HIV (+) male with liver cirrhosis with severe immunosuppression	Oral ribavirin 1200 mg/d (case 1) 1000 mg/d (case 2) for 24 wk	LFT normalized-Liver stiffness improved HEV RNA was detected after the end of treatment in both patients	-
Giordani et al[107]	Case report	60-year-old man with lymphocytic leukemia	1000 mg/d in 2 doses (400 and 600 mg), for 3 mo	HEV cleared and sustained over 6 mo after therapy	Mild anemia (Hgb 10.5 mg/dL)
Kamar et al[100]	Retrospective, multicentre case series	37 kidney, 10 liver, 5 heart, 5 kidneys and pancreas, and 2 lung transplant recipients with chronic HEV	Median dose of 600 mg/d (range 29-1200), for a median of 3 mo (range 1-18 mo)	At the end of the therapy, 95% cleared HEV, 18% recurred after cessation of therapy is stopped, 78% showed SVR	Anemia required dose reduction (29%); use of erythropoietin (54%); required blood transfusion (12%)

LFT: Liver function test; AST: Aspartate aminotransferase; ALT: Alanine transaminase; SVR: Sustained virological response; Hgb: Haemoglobin; GFR: Glomerular filtration rate; HEV: Hepatitis E virus; HIV: Human immunodeficiency virus.