Published online Sep 8, 2015. doi: 10.4254/wjh.v7.i19.2194
Peer-review started: May 7, 2015
First decision: July 1, 2015
Revised: July 28, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: September 8, 2015
Hepatitis E viral infection has traditionally been considered an acute, self-limited, water borne disease similar to hepatitis A, endemic to developing countries. However, over the past decade, zoonotic transmission and progression to chronicity in human patients has been identified, resulting in persistently elevated transaminase levels, progressive liver injury and cirrhosis. In addition to liver injury, neurological, renal and rheumatological manifestations have also been reported. Chronic hepatitis E occurs mainly in immunosuppressed individuals such as transplant recipients, human immunodeficiency virus patients with low CD4 counts and in patients with hematological malignancies receiving chemotherapy. Diagnosis is established by persistent elevation of hepatitis E virus RNA in the stool or serum. This population often requires treatment with antiviral agents, particularly ribavirin, as spontaneous clearance with reduction in immunosuppression occurs only in about a third of the patients. The purpose of this review, is to further discuss the clinical presentation, and recent advances in diagnosis, treatment and prophylaxis of chronic hepatitis E.
Core tip: Chronic hepatitis E occurs mainly in immunosuppressed individuals such as transplant recipients, human immunodeficiency virus patients with low CD4 counts and in patients with hematological malignancies receiving chemotherapy. A few cases have also been reported in immunocompetent individuals. These patients may present with unexplained elevation in transaminases or less frequently with neurological or renal manifestations. The diagnosis is confirmed by a persistent elevation of hepatitis E RNA in serum or stool. Reduction of immunosuppression to achieve spontaneous viral clearance should be attempted. However it is effective only in about a third of patients, therefore most patients require treatment with antiviral agents, like ribavirin. The purpose of this review is to increase awareness amongst physicians of chronic hepatitis E infection as a possible treatable cause of chronic liver disease, especially in immunosuppressed individuals.