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

New Approaches to Treatment, Future Work and Recommendations

Firstly, standardisation of diagnostic assays is a key to ensure as many cases of HEV infection are detected as possible. Work is currently underway to develop World Health Organisation reference materials for HEV serology, which will be available in due course as a worldwide resource. Dedicated studies are required to clarify the optimal dose and treatment duration of ribavirin therapy. With regard to the development of new treatment strategies, targeting viral polymerase may provide a new approach to therapy, and the recent availability of cell culture models/systems will allow new opportunities for the study of HEV biology and the development of targeted therapeutic and/or prophylactic strategies. Deep sequencing technology may prove invaluable in identifying patients at risk of treatment failure with ribavirin; its use may become important in a "personalised medicine" approach to the treatment of chronic HEV infection. 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 made aware of modes of transmission of infection and given advice regarding prevention of infection, eg, routine advice should be given to stem cell and solid organ transplant recipients regarding risk of eating under or poorly cooked pork or pork products. Other attempts to reduce the risk of transmission of infection and infection in high risk patients could include the global use of HEV negative blood in immunosuppressed patients, including the organ and stem cell transplant population. Future clinical trials could include trials of alternative immunosuppression regimens in the transplant population: as described above the role of certain therapies in the development of HEV infection is now recognised, and trials of alternative treatment options for those patients who have failed ribavirin therapy, and/or have the presence of the G1634R mutation are required. Clinicians must be vigilant to the possibility of HEV infection, particularly in elderly men, solid organ transplant recipients and the immunosuppressed, and understand how to manage the patient with HEV infection—see Table 5 .

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