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Hepatitis E: when to treat and how to treat.
Antivir Ther. 2014; 19(2):125-31.AT

Abstract

HEV generally causes a self-limited acute infection and treatment remains supportive. However, severe hepatitis or fulminant hepatic failure may occur, more so during pregnancy. It is an important cause of acute-on-chronic liver failure in endemic areas. Chronic HEV infection and progressive disease has been reported in recipients of solid organ transplants, haematological malignancies, HIV patients and those on haemodialysis. Clearance of HEV may occur after reducing immunosuppressive therapy, especially those targeting T-cells, in about one third of cases. Antiviral therapy should be considered for patients for whom immunosuppressive therapy cannot be reduced and for those who do not achieve viral clearance after reducing immunosuppression. For the patients with severe infection, fulminant hepatic failure and acute-on-chronic infection, ribavirin monotherapy should be considered to expedite the viral clearance and recovery. Although ribavirin therapy is contraindicated in pregnancy owing to teratogenicity, the risks of untreated HEV to the mother and fetus are high and treatment may be offered. A twelve-week course of pegylated interferon, ribavirin or a combination of the two agents leads to viral clearance in about two-thirds of patients with chronic hepatitis E. Three- to twelve-month treatment with pegylated interferon clears virus in liver transplant recipients and patients on haemodialysis. In kidney and heart transplant patients where interferon may lead to organ rejection, ribavirin may be given.

Authors+Show Affiliations

Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan. drzabbas@gmail.com.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24192696

Citation

Abbas, Zaigham, and Rafia Afzal. "Hepatitis E: when to Treat and How to Treat." Antiviral Therapy, vol. 19, no. 2, 2014, pp. 125-31.
Abbas Z, Afzal R. Hepatitis E: when to treat and how to treat. Antivir Ther. 2014;19(2):125-31.
Abbas, Z., & Afzal, R. (2014). Hepatitis E: when to treat and how to treat. Antiviral Therapy, 19(2), 125-31. https://doi.org/10.3851/IMP2705
Abbas Z, Afzal R. Hepatitis E: when to Treat and How to Treat. Antivir Ther. 2014;19(2):125-31. PubMed PMID: 24192696.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatitis E: when to treat and how to treat. AU - Abbas,Zaigham, AU - Afzal,Rafia, Y1 - 2013/11/05/ PY - 2013/10/07/accepted PY - 2013/11/7/entrez PY - 2013/11/7/pubmed PY - 2014/12/15/medline SP - 125 EP - 31 JF - Antiviral therapy JO - Antivir Ther VL - 19 IS - 2 N2 - HEV generally causes a self-limited acute infection and treatment remains supportive. However, severe hepatitis or fulminant hepatic failure may occur, more so during pregnancy. It is an important cause of acute-on-chronic liver failure in endemic areas. Chronic HEV infection and progressive disease has been reported in recipients of solid organ transplants, haematological malignancies, HIV patients and those on haemodialysis. Clearance of HEV may occur after reducing immunosuppressive therapy, especially those targeting T-cells, in about one third of cases. Antiviral therapy should be considered for patients for whom immunosuppressive therapy cannot be reduced and for those who do not achieve viral clearance after reducing immunosuppression. For the patients with severe infection, fulminant hepatic failure and acute-on-chronic infection, ribavirin monotherapy should be considered to expedite the viral clearance and recovery. Although ribavirin therapy is contraindicated in pregnancy owing to teratogenicity, the risks of untreated HEV to the mother and fetus are high and treatment may be offered. A twelve-week course of pegylated interferon, ribavirin or a combination of the two agents leads to viral clearance in about two-thirds of patients with chronic hepatitis E. Three- to twelve-month treatment with pegylated interferon clears virus in liver transplant recipients and patients on haemodialysis. In kidney and heart transplant patients where interferon may lead to organ rejection, ribavirin may be given. SN - 2040-2058 UR - https://www.unboundmedicine.com/medline/citation/24192696/Hepatitis_E:_when_to_treat_and_how_to_treat_ L2 - http://www.diseaseinfosearch.org/result/3334 DB - PRIME DP - Unbound Medicine ER -