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Treatment of autochthonous acute hepatitis E with short-term ribavirin: a multicenter retrospective study.
Liver Int. 2016 Mar; 36(3):328-33.LI

Abstract

BACKGROUND & AIMS

Hepatitis E virus (HEV) genotypes 3 and 4 cause sporadic cases of infection in developed countries. Being elderly and having an underlying liver disease are the main risk factors for death in this population. Chronic infection has been described in immunocompromised patients. Ribavirin is now the antiviral treatment of choice in solid-organ-transplant recipients with chronic HEV infection. We hypothesized that early short-term treatment of acute HEV infection may be useful for patients with risk factors or undergoing chemotherapy.

METHODS

Between July 2010 and January 2014, 21 patients diagnosed with acute HEV infection were treated with ribavirin, at 600-800 mg/day for up to 3 months. All serum samples were positive for HEV RNA.

RESULTS

Nine patients were treated for severe hepatitis. Six patients were aged >70 years. Four patients were receiving an immunosuppressive therapy for an autoimmune disease and two patients were undergoing chemotherapy for a malignancy. Two patients received a fixed-dose regimen. For all other patients, ribavirin was stopped when HEV became undetectable in the serum. The median duration of ribavirin treatment was 26 days. Two patients developed severe anaemia. Two patients with encephalopathy died. One patient relapsed transiently. All patients were cleared of HEV and regained normalized liver-enzyme levels. Immunosuppressive treatment and chemotherapy could be resumed.

CONCLUSIONS

Treatment of acute HEV infection using ribavirin seems safe and effective. Short-term treatment tailored to viraemia may be the best regimen for this indication.

Authors+Show Affiliations

Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.Laboratoire de Virologie, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, INSERM, UMR 1043, Centre de Physiopathologie de Toulouse, Toulouse, France.Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France. INSERM U1048, Institute of Metabolic and Cardiovascular Diseases I2MC, Université Paul Sabatier Toulouse III, Toulouse, France.Service d'Hépato-gastroentérologie, Hôpital de la Conception, Centre Hospitalier Universitaire de Marseille, Université de Marseille, Marseille, France.Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire de Nice, Université de Nice-Sophia-Antipolis, INSERM U1065, Nice, France.Service d'Hépato-gastroentérologie, Centre Hospitalier de Pau, Pau, France.Service d'Hépato-gastroentérologie, Hôpital de Hyères, Hyères, France.Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.Service de Médecine Interne, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.Service d'Hépato-gastroentérologie, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, Toulouse, France.Laboratoire de Virologie, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, INSERM, UMR 1043, Centre de Physiopathologie de Toulouse, Toulouse, France.Service de Néphrologie et transplantation d'organes, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier Toulouse III, INSERM, UMR 1043, Toulouse, France.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26179015

Citation

Péron, Jean Marie, et al. "Treatment of Autochthonous Acute Hepatitis E With Short-term Ribavirin: a Multicenter Retrospective Study." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 36, no. 3, 2016, pp. 328-33.
Péron JM, Abravanel F, Guillaume M, et al. Treatment of autochthonous acute hepatitis E with short-term ribavirin: a multicenter retrospective study. Liver Int. 2016;36(3):328-33.
Péron, J. M., Abravanel, F., Guillaume, M., Gérolami, R., Nana, J., Anty, R., Pariente, A., Renou, C., Bureau, C., Robic, M. A., Alric, L., Vinel, J. P., Izopet, J., & Kamar, N. (2016). Treatment of autochthonous acute hepatitis E with short-term ribavirin: a multicenter retrospective study. Liver International : Official Journal of the International Association for the Study of the Liver, 36(3), 328-33. https://doi.org/10.1111/liv.12911
Péron JM, et al. Treatment of Autochthonous Acute Hepatitis E With Short-term Ribavirin: a Multicenter Retrospective Study. Liver Int. 2016;36(3):328-33. PubMed PMID: 26179015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of autochthonous acute hepatitis E with short-term ribavirin: a multicenter retrospective study. AU - Péron,Jean Marie, AU - Abravanel,Florence, AU - Guillaume,Maeva, AU - Gérolami,René, AU - Nana,Jean, AU - Anty,Rodolphe, AU - Pariente,Alexandre, AU - Renou,Christophe, AU - Bureau,Christophe, AU - Robic,Marie-Angèle, AU - Alric,Laurent, AU - Vinel,Jean Pierre, AU - Izopet,Jacques, AU - Kamar,Nassim, Y1 - 2015/12/30/ PY - 2015/05/20/received PY - 2015/07/02/accepted PY - 2015/7/17/entrez PY - 2015/7/17/pubmed PY - 2016/12/15/medline KW - acute hepatitis KW - antiviral therapy KW - cirrhosis KW - hepatitis E KW - immunodeficiency SP - 328 EP - 33 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int VL - 36 IS - 3 N2 - BACKGROUND & AIMS: Hepatitis E virus (HEV) genotypes 3 and 4 cause sporadic cases of infection in developed countries. Being elderly and having an underlying liver disease are the main risk factors for death in this population. Chronic infection has been described in immunocompromised patients. Ribavirin is now the antiviral treatment of choice in solid-organ-transplant recipients with chronic HEV infection. We hypothesized that early short-term treatment of acute HEV infection may be useful for patients with risk factors or undergoing chemotherapy. METHODS: Between July 2010 and January 2014, 21 patients diagnosed with acute HEV infection were treated with ribavirin, at 600-800 mg/day for up to 3 months. All serum samples were positive for HEV RNA. RESULTS: Nine patients were treated for severe hepatitis. Six patients were aged >70 years. Four patients were receiving an immunosuppressive therapy for an autoimmune disease and two patients were undergoing chemotherapy for a malignancy. Two patients received a fixed-dose regimen. For all other patients, ribavirin was stopped when HEV became undetectable in the serum. The median duration of ribavirin treatment was 26 days. Two patients developed severe anaemia. Two patients with encephalopathy died. One patient relapsed transiently. All patients were cleared of HEV and regained normalized liver-enzyme levels. Immunosuppressive treatment and chemotherapy could be resumed. CONCLUSIONS: Treatment of acute HEV infection using ribavirin seems safe and effective. Short-term treatment tailored to viraemia may be the best regimen for this indication. SN - 1478-3231 UR - https://www.unboundmedicine.com/medline/citation/26179015/Treatment_of_autochthonous_acute_hepatitis_E_with_short_term_ribavirin:_a_multicenter_retrospective_study_ L2 - https://doi.org/10.1111/liv.12911 DB - PRIME DP - Unbound Medicine ER -