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World J Hepatol. Mar 27, 2022; 14(3): 482-494
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.482
Hepatitis E in immunocompromised individuals
Konstantinos Damiris, Mohamad Aghaie Meybodi, Mumtaz Niazi, Nikolaos Pyrsopoulos
Konstantinos Damiris, Mohamad Aghaie Meybodi, Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
Mumtaz Niazi, Nikolaos Pyrsopoulos, Department of Medicine - Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States
Author contributions: Damiris K, Aghaie Meybodi M, Niazi M and Pyrsopoulos N equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision/editing; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors do not have any conflicts of interest relevant to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantinos Damiris, DO, MS, Doctor, Department of Medicine, Rutgers - New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, United States. kd705@njms.rutgers.edu
Received: October 12, 2021
Peer-review started: October 12, 2021
First decision: December 2, 2021
Revised: December 15, 2021
Accepted: February 12, 2022
Article in press: February 12, 2022
Published online: March 27, 2022
Processing time: 162 Days and 23.5 Hours
Abstract

Hepatitis E virus (HEV) originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States. While there are eight identified genotypes to date, genotype 1 (HEV1), HEV2, HEV3, HEV4 are the most common to infect humans. HEV1 and HEV2 are most common in developing countries including Latina America, Africa and Asia, and are commonly transmitted through contaminated water supplies leading to regional outbreaks. In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat. The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing. In majority of cases, HEV infection is a self-limiting hepatitis requiring only symptomatic treatment. However, this is not the case in immunocompromised individuals, including those that have undergone solid organ or stem cell transplantation. In this subset of patients, chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death. The need for re-transplantation as a result of post-transplant hepatitis is of great concern. In addition, there have been many reported incidents of extrahepatic manifestations, for which the exact mechanisms remain to be elucidated. The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies, while attempting to minimize the risk of organ rejection. Subsequent treatment options include ribavirin, and pegylated interferon alpha in those who have demonstrated ribavirin resistance. Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden. Given this concern, vaccination has been approved in China with other investigations underway throughout the world. In this review we introduce the epidemiology, diagnosis, clinical manifestations, and treatment of HEV, with emphasis on immunocompromised individuals in the United States.

Keywords: Hepatitis E; Hepatitis E virus; Chronic hepatitis; Acute hepatitis; Immunocompromised; Liver transplant

Core Tip: Hepatitis E Virus is a leading cause of acute icteric hepatitis in developing countries. Despite being self- limiting in most cases, immunocompromised individuals are at a risk of chronic hepatitis, which can be life threatening. Hallmark of treatment includes reduction of immunosuppressive therapies followed by possible need of anti-viral therapy, which has shown to be ineffective.