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Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment.
World J Gastroenterol. 2020 Oct 07; 26(37):5543-5560.WJ

Abstract

The hepatitis E virus (HEV) is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s. Globally, it is one of the most frequent causes of acute viral hepatitis. The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus. Among the eight different genotypes identified to date, HEV genotype 1 (HEV1), HEV2, HEV3, and HEV4 are the most frequent genotypes causing infections in humans. HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies. They are also responsible for severe hepatitis in pregnant patients and infants. In contrast, HEV3 and HEV4 are zoonotic, and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals. Their main reservoir is the pig, and they are mostly encountered in developed countries. The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women, infants, older people, immunocompromised individuals, patients with underlying chronic liver diseases, and workers that come into close contact with HEV-infected animals. In the clinical perspective, HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis, acute-on-chronic liver disease, chronic hepatitis, cirrhosis, and liver failure. Although HEV mainly results in acute self-limiting infection, chronic HEV infection may occur among immunocompromised patients (e.g., solid-organ transplant recipients). Additionally, HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade, although the causal link for many of them still needs to be proven. Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success. However, ribavirin is contraindicated in pregnant patients, and interferon-alpha cannot be used in most transplant recipients. Therefore, there is an urgent need for novel antiviral compounds that are safe and effective particularly for patients having contraindications for ribavirin or interferon-alpha and infected by the ribavirin-resistant HEV. In this review article, a literature search using PubMed and MEDLINE databases was performed, up to March 2020. Only the articles published in English were reviewed.

Authors+Show Affiliations

Department of Internal Medicine, Gölhisar State Hospital, Burdur 15100, Turkey.Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey. yhbalaban@gmail.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33071523

Citation

Aslan, Abdullah Tarık, and Hatice Yasemin Balaban. "Hepatitis E Virus: Epidemiology, Diagnosis, Clinical Manifestations, and Treatment." World Journal of Gastroenterology, vol. 26, no. 37, 2020, pp. 5543-5560.
Aslan AT, Balaban HY. Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment. World J Gastroenterol. 2020;26(37):5543-5560.
Aslan, A. T., & Balaban, H. Y. (2020). Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment. World Journal of Gastroenterology, 26(37), 5543-5560. https://doi.org/10.3748/wjg.v26.i37.5543
Aslan AT, Balaban HY. Hepatitis E Virus: Epidemiology, Diagnosis, Clinical Manifestations, and Treatment. World J Gastroenterol. 2020 Oct 7;26(37):5543-5560. PubMed PMID: 33071523.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment. AU - Aslan,Abdullah Tarık, AU - Balaban,Hatice Yasemin, PY - 2020/06/28/received PY - 2020/08/11/revised PY - 2020/09/10/accepted PY - 2020/10/19/entrez PY - 2020/10/20/pubmed PY - 2020/10/20/medline KW - Acute hepatitis KW - Chronic hepatitis KW - Extrahepatic manifestations KW - Hepatitis E KW - Hepatitis E virus KW - Zoonotic infection SP - 5543 EP - 5560 JF - World journal of gastroenterology JO - World J Gastroenterol VL - 26 IS - 37 N2 - The hepatitis E virus (HEV) is the fifth known form of viral hepatitis and was first recognized as the cause of an epidemic of unexplained acute hepatitis in the early 1980s. Globally, it is one of the most frequent causes of acute viral hepatitis. The majority of HEV infections are asymptomatic and lead to the spontaneous clearance of the virus. Among the eight different genotypes identified to date, HEV genotype 1 (HEV1), HEV2, HEV3, and HEV4 are the most frequent genotypes causing infections in humans. HEV1 and HEV2 are prevalent in developing regions and able to result in large-scale outbreaks originating from contaminated water supplies. They are also responsible for severe hepatitis in pregnant patients and infants. In contrast, HEV3 and HEV4 are zoonotic, and the transmission of these genotypes to humans occurs mainly through the fecal contamination of water and consumption of contaminated meat from infected animals. Their main reservoir is the pig, and they are mostly encountered in developed countries. The major risk groups for HEV infection and its ensuing adverse consequences are pregnant women, infants, older people, immunocompromised individuals, patients with underlying chronic liver diseases, and workers that come into close contact with HEV-infected animals. In the clinical perspective, HEV infections have diverse clinical manifestations including acute and self-limiting hepatitis, acute-on-chronic liver disease, chronic hepatitis, cirrhosis, and liver failure. Although HEV mainly results in acute self-limiting infection, chronic HEV infection may occur among immunocompromised patients (e.g., solid-organ transplant recipients). Additionally, HEV-associated extrahepatic manifestations involving various organs have been reported in the last decade, although the causal link for many of them still needs to be proven. Ribavirin and interferon-alpha are the most widely used agents for the treatment of HEV infections with a certain level of success. However, ribavirin is contraindicated in pregnant patients, and interferon-alpha cannot be used in most transplant recipients. Therefore, there is an urgent need for novel antiviral compounds that are safe and effective particularly for patients having contraindications for ribavirin or interferon-alpha and infected by the ribavirin-resistant HEV. In this review article, a literature search using PubMed and MEDLINE databases was performed, up to March 2020. Only the articles published in English were reviewed. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/33071523/Hepatitis_E_virus:_Epidemiology_diagnosis_clinical_manifestations_and_treatment_ L2 - https://www.wjgnet.com/1007-9327/full/v26/i37/5543.htm DB - PRIME DP - Unbound Medicine ER -
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