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Hepatitis E virus genotype 3 infection in a tertiary referral center in the Netherlands: Clinical relevance and impact on patient morbidity.
J Clin Virol. 2016 Jan; 74:82-7.JC

Abstract

BACKGROUND

Hepatitis E virus (HEV) genotype 3 infections can have important clinical consequences.

OBJECTIVES

To evaluate patients at risk and the effect of treatment strategies, we studied the clinical course and treatment outcome in patients diagnosed with HEV viremia in our hospital.

STUDY DESIGN

Between January 2008 and March 2015 we included all patients with HEV genotype 3 (HEV-3) infections diagnosed by means of quantitative real-time reverse transcription-polymerase chain reaction test (RT-PCR). Clinical data were evaluated retrospectively.

RESULTS

In total 79 patients were included. Forty-nine patients (62%) were male, median age of all patients was 52 years (range 13-79). Sixty-one (77%) patients were immunocompromised. Three patients (3.8%) had only transient viremia, forty-three (54.5%) cleared the infection within six months and twenty-six (32.9%) developed chronic infection. Five patients (6.3%) were lost to follow-up. All patients developing chronic infection were immunocompromised. Overall, thirteen (16%) patients within this cohort died. Three patients had pre-existent liver diseases and died of liver-related causes. Time between diagnosis and death was shorter for patients with pre-existent liver diseases (p=0.03). Twenty-eight percent of patients on immunosuppressive medication achieved viral clearance after reducing the dose of immunosuppressive therapy. Thirty patients (38.0%) were treated with off-label ribavirin in which 25 (83.3%) a sustained viral response has been documented.

CONCLUSION

HEV genotype 3 viremia mainly presents in patients with underlying chronic liver diseases or an impaired immune system. Patients with pre-existent liver diseases are at high risk for complications and even death. The off-label use of ribavirin can cure HEV infection.

Authors+Show Affiliations

Erasmus MC, University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, PO Box 2040, 3000CA Rotterdam, The Netherlands.Erasmus MC, University Medical Center Rotterdam, Department of Viroscience, PO Box 2040, 3000CA Rotterdam, The Netherlands.Erasmus MC, University Medical Center Rotterdam, Department of Haematology, PO Box 2040, 3000CA Rotterdam, The Netherlands.Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, PO Box 2040, 3000CA Rotterdam, The Netherlands.Erasmus MC, University Medical Center Rotterdam, Department of Pulmonology, PO Box 2040, 3000CA Rotterdam, The Netherlands.Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, PO Box 2040, 3000CA Rotterdam, The Netherlands.Erasmus MC, University Medical Center Rotterdam, Department of Viroscience, PO Box 2040, 3000CA Rotterdam, The Netherlands.Erasmus MC, University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, PO Box 2040, 3000CA Rotterdam, The Netherlands. Electronic address: r.deman@erasmusmc.nl.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26687439

Citation

Nijskens, Charlotte M., et al. "Hepatitis E Virus Genotype 3 Infection in a Tertiary Referral Center in the Netherlands: Clinical Relevance and Impact On Patient Morbidity." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 74, 2016, pp. 82-7.
Nijskens CM, Pas SD, Cornelissen J, et al. Hepatitis E virus genotype 3 infection in a tertiary referral center in the Netherlands: Clinical relevance and impact on patient morbidity. J Clin Virol. 2016;74:82-7.
Nijskens, C. M., Pas, S. D., Cornelissen, J., Caliskan, K., Hoek, R. A., Hesselink, D. A., van der Eijk, A. A., & de Man, R. A. (2016). Hepatitis E virus genotype 3 infection in a tertiary referral center in the Netherlands: Clinical relevance and impact on patient morbidity. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 74, 82-7. https://doi.org/10.1016/j.jcv.2015.11.038
Nijskens CM, et al. Hepatitis E Virus Genotype 3 Infection in a Tertiary Referral Center in the Netherlands: Clinical Relevance and Impact On Patient Morbidity. J Clin Virol. 2016;74:82-7. PubMed PMID: 26687439.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatitis E virus genotype 3 infection in a tertiary referral center in the Netherlands: Clinical relevance and impact on patient morbidity. AU - Nijskens,Charlotte M, AU - Pas,Suzan D, AU - Cornelissen,Jan, AU - Caliskan,Kadir, AU - Hoek,Rogier A S, AU - Hesselink,Dennis A, AU - van der Eijk,Annemiek A, AU - de Man,Robert A, Y1 - 2015/12/02/ PY - 2015/10/01/received PY - 2015/11/27/revised PY - 2015/11/29/accepted PY - 2015/12/22/entrez PY - 2015/12/22/pubmed PY - 2016/11/15/medline KW - Chronic disease KW - HEV KW - Hepatitis E KW - Pre-existent liver disease KW - Ribavirin KW - Solid organ transplant SP - 82 EP - 7 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J Clin Virol VL - 74 N2 - BACKGROUND: Hepatitis E virus (HEV) genotype 3 infections can have important clinical consequences. OBJECTIVES: To evaluate patients at risk and the effect of treatment strategies, we studied the clinical course and treatment outcome in patients diagnosed with HEV viremia in our hospital. STUDY DESIGN: Between January 2008 and March 2015 we included all patients with HEV genotype 3 (HEV-3) infections diagnosed by means of quantitative real-time reverse transcription-polymerase chain reaction test (RT-PCR). Clinical data were evaluated retrospectively. RESULTS: In total 79 patients were included. Forty-nine patients (62%) were male, median age of all patients was 52 years (range 13-79). Sixty-one (77%) patients were immunocompromised. Three patients (3.8%) had only transient viremia, forty-three (54.5%) cleared the infection within six months and twenty-six (32.9%) developed chronic infection. Five patients (6.3%) were lost to follow-up. All patients developing chronic infection were immunocompromised. Overall, thirteen (16%) patients within this cohort died. Three patients had pre-existent liver diseases and died of liver-related causes. Time between diagnosis and death was shorter for patients with pre-existent liver diseases (p=0.03). Twenty-eight percent of patients on immunosuppressive medication achieved viral clearance after reducing the dose of immunosuppressive therapy. Thirty patients (38.0%) were treated with off-label ribavirin in which 25 (83.3%) a sustained viral response has been documented. CONCLUSION: HEV genotype 3 viremia mainly presents in patients with underlying chronic liver diseases or an impaired immune system. Patients with pre-existent liver diseases are at high risk for complications and even death. The off-label use of ribavirin can cure HEV infection. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/26687439/Hepatitis_E_virus_genotype_3_infection_in_a_tertiary_referral_center_in_the_Netherlands:_Clinical_relevance_and_impact_on_patient_morbidity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-6532(15)00782-9 DB - PRIME DP - Unbound Medicine ER -