Review Article

Hepatitis E—A Concise Review of Virology, Epidemiology, Clinical Presentation and Therapy

M. C. Donnelly; L. Scobie; C. L. Crossan; H. Dalton; P. C. Hayes; K. J. Simpson

Disclosures

Aliment Pharmacol Ther. 2017;46(2):126-141. 

In This Article

Abstract and Introduction

Abstract

Background: Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure.

Aim: To detail current understanding of the molecular biology of HEV, diagnostic and therapeutic strategies and propose future directions for basic science and clinical research.

Methods: PubMed was searched for English language articles using the key words "hepatitis E", "viral hepatitis", "autochthonous infection", "antiviral therapy", "liver transplantation", "acute", "chronic", "HEV", "genotype", "transmission" "food-borne", "transfusion". Additional relevant publications were identified from article reference lists.

Results: There has been increasing recognition of autochthonous HEV infection in Western countries, mainly associated with genotype 3. Chronic HEV infection has been recognised since 2008, and in transplant recipients this may lead to cirrhosis and organ failure. Modes of transmission include food-borne transmission, transfusion of blood products and solid organ transplantation. Ribavirin therapy is used to treat patients with chronic HEV infection, but new therapies are required as there have been reports of treatment failure with ribavirin.

Conclusions: Autochthonous HEV infection is a clinical issue with increasing burden. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.

Introduction

Hepatitis E (HEV) was initially identified in the late 1970s as an epidemic non-A non-B hepatitis that caused an infectious water-borne illness similar to hepatitis A.[1] Now, HEV is a leading cause of icteric hepatitis and acute liver failure in the developing world. Worldwide, the estimated annual incidence of HEV infection is 20 million, resulting in around 56 600 deaths.[2] Predominantly, infections are recognised as occurring in developing countries as large epidemics due to poor sanitation and are mainly associated with what are known as genotypes 1 and 2. In this instance, pregnant individuals are more susceptible to severe infection, and often develop a more aggressive clinical course associated with a poor outcome (3000 stillbirths annually are reportedly caused by HEV[3]). Over the course of the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in Western countries, mainly associated with genotype 3.[4,5] Worldwide endemicity for HEV (all genotypes) is detailed in Figure 1.[6] Furthermore, chronic HEV infection has been recognised since 2008,[7] and in transplant recipients this may lead to cirrhosis and organ failure.[8]

Figure 1.

Worldwide endemicity for Hepatitis E virus infection

In this review, we detail current understanding of the molecular biology of HEV, clinical relevance of genotypic HEV infection, diagnostic and therapeutic strategies and propose future directions for basic science and clinical research.

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