Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 8, 2015; 7(19): 2194-2201
Published online Sep 8, 2015. doi: 10.4254/wjh.v7.i19.2194
Chronic hepatitis E: A brief review
Arvind R Murali, Vikram Kotwal, Saurabh Chawla
Arvind R Murali, Department of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA 52246, United States
Vikram Kotwal, Department of Gastroenterology, St. Mary’s Hospital, Decatur, IL 62521, United States
Saurabh Chawla, Grady Memorial Hospital and Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: Murali AR and Kotwal V contributed significantly to manuscript preparation and revision; Kotwal V and Chawla S contributed significantly to conception, interpretation and revision.
Conflict-of-interest statement: No conflicts of interest for all authors in the study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Saurabh Chawla, MD, Assistant Professor of Medicine, Director of Interventional Endoscopy, Grady Memorial Hospital and Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Faculty Office Building, 49 Jesse Hill Jr. Drive, Suite 431, Atlanta, GA 30322, United States.
Telephone: +1-140-47781684 Fax: +1-140-47781681
Received: April 30, 2015
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
Core Tip

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.