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©The Author(s) 2015.
World J Virology. Nov 12, 2015; 4(4): 343-355
Published online Nov 12, 2015. doi: 10.5501/wjv.v4.i4.343
Published online Nov 12, 2015. doi: 10.5501/wjv.v4.i4.343
Table 1 Global prevalence of anti-hepatitis E virus IgG in different populations
Regions | Prevalence (%) | Ref. |
Low-to-medium income | ||
Kashmir region | 49.6 | Khuroo et al[35] |
India | 23.8-28.7 | Mathur et al[76] |
Myanmar | 32.0 | Nakai et al[77] |
Egypt | 67.7 | Stoszek et al[71] |
Bangladesh | 22.5 | Labrique et al[78] |
China | 19.7 | Dong et al[79] |
Mexico | 36.6 | Alvarado-Esquivel et al[80] |
Thailand | 14.0 | Gonwong et al[75] |
Nigeria | 42.7 | Junaid et al[81] |
Industrialized | ||
Germany | 17.0 | Wenzel et al[82] |
United States | 6.0 | Teshale et al[83] |
Table 2 Recent evidences on the outcome of therapies against acute hepatitis E infection
Ref. | Type of study | Patient profile | HEV genotype | Ribavirin regimen | Results |
Gerolami et al[84] | Case report | 61-year-old man, 7 d after admission ALT 4565 IU/L | 3 | 1200 mg/d for 21 d | At day 21 of treatment, ALT normalized, RNA almost undetectable |
Péron et al[88] | Case report | 79-year-old man with chronic liver disease, acute kidney failure | 3f | 200 mg/d for 3 mo | Serum HEV RNA negative at 1 mo therapy, stopped dialysis at 2 mo |
A patient with chronic liver disease | 3f | 1000 mg/d for 10 d | Viral load 4.07 log copies/mL declined to 2.54 log copies/mL at day 6, Hgb 12.6 g/dL declined to 11.6 g/dL at day 6 of treatment | ||
Del Bello et al[95] | Case report | 65-year-old man, liver transplant recipient Guillain-Barré syndrome with severe necrotizing myositis | 3f | 400 mg/d adapted to GFR (40 mL/min) for 3 mo | HEV RNA undetectable by day 15, progressive recovery of mobility |
Pischke et al[96] | Case from prospective case series | 42-year-old woman had traveled to Eritrea and acquired severe acute hepatitis E | 1e | For 6 wk (dose: Undefined) | Rapidly improved liver function and cleared HEV |
Robbins et al[97] | Case report | 39-year-old man HIV (+) CD4 51/mm3 prothrombin index 45% | 3c | 1200 mg/d (15 mg/kg per day) for 12 wk | Gradual normalization of LFT-HEV RNA decreased to < 100 copies/mL at 1 mo of treatment |
Riveiro-Barciela et al[98] | Case report | 68-year-old man with Waldenström's macroglobulinemia | 3f | 800 mg/d for 12 wk | Achieved SVR after 12 wk; no ribavirin-related side effect reported |
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%) |
Table 4 Treatment of chronic hepatitis E virus with pegylated interferon-α therapy
Ref. | Patient profile | Peg-IFN-α regimen | Result | Adverse effects |
Kamar et al[101] | 29-year-old man with liver transplantation | Peg-IFN-α-2a for 12 wk (135 μg/wk) | Liver enzyme levels decreased. HEV RNA levels remained undetectable until week 12 | At week 12, signs of acute humoral rejection in liver biopsy |
26-year-old man with liver transplantation | Peg-IFN-α-2a for 12 wk (135 μg/wk) | HEV RNA levels undetectable by week 12; liver enzyme levels normalized by week 12 | ||
58-year-old man with liver transplantation liver cirrhosis from chronic HEV infection | Peg-IFN-α-2a for 12 wk (135 μg/wk) | HEV RNA was redetected 2 wk after completion of treatment; Liver enzyme levels normalized by 3 mo of therapy | ||
Haagsma et al[102] | 37-year-old woman with liver transplantation | Peg-IFN-α-2b for 52 wk (80 μg/wk declined to 60 μg/wk) | Serum HEV RNA sustained undetectable during 3 mo follow-up; serum liver enzyme became normalized | |
59-year-old man with liver transplantation | Peg-IFN-α-2b 150 μg/wk, dose reduction due to leukopenia | HEV viral load and aminotransferases declined, but Peg-IFN discontinued from lack of further efficacy, HEV RNA level undetectable at 4 wk after the discontinuation of Peg-IFN and aminotransferase normalized | Leukopenia | |
Alric et al[108] | 57-year-old man with hairy cell leukemia | Discontinued at week 16, Peg-IFN-α-2b 1 μg/kg per week for 3 mo | Achieved a complete virologic response by week 4 | |
Kamar et al[109] | 24-year-old man with kidney transplantation, kidney failure from chronic HEV infection | 3-mo Peg-IFN-α-2a 135 μg/wk | Serum RNA undetectable after 5 mo, SVR for 6 mo after treatment | Acute rejection of the kidney allograft by month 3 of Peg-IFN therapy |
Table 5 Incidence of detectable hepatitis E virus in blood donors (hepatitis E virus-RNA)
Year of study | Countries | Technique used for detection | No. of tests | Ratio of positive detections | Ref. |
2005 | China | Real-time fluorescence RT-PCR | 10741 | 1:1094 | Ren et al[117] |
2011 | England | PCR | 42000 | 1:7000 | Ijaz et al[118] |
2011 | German | Real-time RT-PCR | 18100 | 1:4525 | Baylis et al[119] |
2011 | Sweden | Real-time RT-PCR | 95835 | 1:7986 | Baylis et al[119] |
2011 | United States | Real-time RT-PCR | 51075 | None detected | Baylis et al[119] |
2011 | German | Real-time RT-PCR | 16125 | 1:1241 | Vollmer et al[120] |
2011-2012 | The Netherlands | Real-time PCR | 45415 | 1:2672 | Slot et al[121] |
2012-2013 | England | RT-PCR | 225000 | 1:2848 | Hewitt et al[122] |
2012 | France | RT-PCR | 53234 | 1:2218 | Gallian et al[123] |
2013 | Spain | Transcription-mediated amplification assay | 9998 | 1:3333 | Sauleda et al[124] |
- Citation: Lee GY, Poovorawan K, Intharasongkroh D, Sa-nguanmoo P, Vongpunsawad S, Chirathaworn C, Poovorawan Y. Hepatitis E virus infection: Epidemiology and treatment implications. World J Virology 2015; 4(4): 343-355
- URL: https://www.wjgnet.com/2220-3249/full/v4/i4/343.htm
- DOI: https://dx.doi.org/10.5501/wjv.v4.i4.343