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World J Virol. Dec 25, 2023; 12(5): 262-271
Published online Dec 25, 2023. doi: 10.5501/wjv.v12.i5.262
Hepatitis E infection: A review
Humzah Iqbal, Bilal Fazal Mehmood, Aalam Sohal, Marina Roytman
Humzah Iqbal, Bilal Fazal Mehmood, Department of Internal Medicine, University of California San Francisco, Fresno, CA 93701, United States
Aalam Sohal, Department of Hepatology, Liver Institute Northwest, Seattle, WA 98105, United States
Marina Roytman, Department of Gastroenterology and Hepatology, University of California San Francisco, Fresno, CA 93701, United States
Author contributions: Iqbal H and Mehmood BF performed majority of the data acquisition, writing, and created figures; Sohal A and Roytman M coordinated the writing, provided input, and revised the manuscript for important intellectual content; All authors have read and approved the final version to be published.
Conflict-of-interest statement: There are no conflicts of interest associated with any of the authors of this manuscript.
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: Aalam Sohal, MD, Research Fellow, Department of Hepatology, Liver Institute Northwest, 3216 NE 45th Pl Suite 212, Seattle, WA 98105, United States. asohal@liverinstitutenw.org
Received: October 11, 2023
Peer-review started: October 11, 2023
First decision: November 21, 2023
Revised: November 23, 2023
Accepted: December 5, 2023
Article in press: December 5, 2023
Published online: December 25, 2023
Processing time: 74 Days and 14.4 Hours
Abstract

Hepatitis E virus (HEV) is a small non-enveloped virus that is transmitted via the fecal-oral route. It is a highly common cause of acute hepatitis, particularly in low to middle income regions of Asia, Africa, and Central America. Most cases are self-limited, and symptomatic patients usually present with acute icteric hepatitis. A subset of patients including pregnant women, older men, those with pre-existing liver disease and immunocompromised patients however, may develop severe disease and hepatic failure. Immunocompromised patients are also at risk for chronic infection, and their immunosuppression should be decreased in order to facilitate viral clearance. HEV can also present with a variety of extra-intestinal manifestations including neurological, renal, hematological, and pancreatic derangements. The gold standard of diagnosis is HEV ribonucleic acid detection via nucleic acid amplification testing. Currently, there are no approved treatments for Hepatitis E, though ribavirin is the most commonly used agent to reduce viral load. Studies assessing the safety and efficacy of other antiviral agents for HEV are currently underway. HEV vaccination has been approved in China, and is currently being investigated in other regions as well. This review article aims to discuss the epidemiology, pathogenesis, presentation, diagnosis, complications, and treatment of Hepatitis E infection.

Keywords: Hepatitis E; Acute hepatitis; Chronic hepatitis; Viral hepatitis; Vaccination

Core Tip: Hepatitis E is a common viral infection that has been increasing in developed nations. It usually causes a self-resolving acute hepatitis. It can sometimes lead to chronic hepatitis, and even cirrhosis/hepatic failure. Several subtypes exist, however the types responsible for infections in humans are generally spread via pork consumption or contaminated water. Treatment is usually supportive, however, ribavirin has shown efficacy in those with severe or chronic infection. Immunocompromised and pregnant patients should be evaluated with particular caution. Vaccination is currently licensed in China, and many studies are underway assessing vaccination efficacy in other nations as well.