Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections

Lhomme, Sébastien; Marion, Olivier; Abravanel, Florence; Izopet, Jacques; Kamar, Nassim

doi:10.3390/jcm9020331

Cited by 102 publications

(100 citation statements)

References 209 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Overall, GT3 is responsible for the majority of the autochthonous cases in Europe [ 14 ]. Seroprevalence in European countries ranges from 5% [ 15 , 16 ] to 50% in some regions of Southern France [ 17 ]. Differences in seroprevalence may be a consequence of the sensitivity of the anti-HEV antibody detection assay employed [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

et al. 2020

View full text Add to dashboard Cite

Genotype 3 (GT3) is responsible for most European autochthonous hepatitis E virus (HEV) infections. This study analyzed circulating genotypes and GT3 subtypes in the Lazio region, Italy, between 2011 and 2019, as well as their pathogenic characteristics. Of the 64 evaluable HEV GT3 patient-derived sequences, identified subtypes included GT3f (n = 36), GT3e (n = 15), GT3c (n = 9), GT3a (n = 1) and three unsubtyped GT3 sequences. GT3c strains were similar to Dutch sequences (96.8–98.1% identity), GT3e strains showed high similarity (96.8%) with a United Kingdom sequence, while the most related sequences to GT3f Italian strains were isolated in France, Belgium and Japan. One sequence was closely related to another Italian strain isolated in raw sewage in 2016. The liver functioning test median values for 56 evaluable GT3 patients were: alanine aminotransferase (ALT), 461 (range 52–4835 U/L); aspartate aminotransferase (AST), 659 (range 64–6588 U/L); and total bilirubin, 3.49 (range 0.4–33 mg/dL). The median HEV RNA viral load for 26 evaluable GT3 patients was 42,240 IU/mL (range 5680–895,490 IU/mL). Of the 37 GT3 patients with available clinical information, no correlation was observed between HEV clinical manifestations and GT3 subtype. HEV symptoms were comparable among GT3c/e/f patients across most analyzed categories except for epigastric pain, which occurred more frequently in patients with HEV GT3e (75%) than in patients with GT3c (50%) or GT3f (19%) (p = 0.01). Additionally, patients with HEV GT3c exhibited significantly higher median international normalized ratio (INR) than patients with GT3e and GT3f (p = 0.033). The severity of GT3 acute hepatitis E was not linked to HEV RNA viral load or to the GT3 subtype.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In immunocompromised individuals who receive immunosuppressive therapy following solid organ transplantation or stem cell transplantation [75][76][77] and those with human immunodeficiency virus (HIV) infection [78,79] or with hematological malignancy [80][81][82], chronic HEV infection may develop. This disease course of chronic infection has mainly been reported for HEV-3 and 4, leading to life-threatening liver fibrosis and cirrhosis [75,80,[83][84][85]. It has been reported that HEV-3 can cause acute hepatitis E in pregnant women, followed by rapid clearance without any signs of severe courses [50,51].…”

Section: Chronic Hepatitis Ementioning

confidence: 96%

“…Acute or chronic or previous HEV infection can cause extrahepatic manifestations [86,87], which include a range of neurological symptoms and impaired kidney function associated with cryoglobulinemia [84,88]. Other extrahepatic manifestations documented in the literature include acute thyroiditis [89], thrombocytopenia [90], and acute pancreatitis [91].…”

Section: Extrahepatic Manifestations Of Hepatitis Ementioning

confidence: 99%

Hepatitis E virus infection during pregnancy

Xia

2020

Virol J

View full text Add to dashboard Cite

Background: Hepatitis E virus (HEV) generally causes self-limiting viral hepatitis. However, in pregnant women, HEV infection can be severe and has been associated with up to 30% mortality in the third trimester. Additionally, HEV infection in pregnancy is also associated with high rates of preterm labor and vertical transmission. Main body: HEV is now recognized as a global health problem in both developing and industrialized countries. HEV can be transmitted via the fecal-oral route, zoonotic route, and blood transfusion route. An altered immune status, hormonal levels, and viral factors may be related to the severity of the disease. Currently, no established treatment is available for HEV in pregnant women. A Chinese vaccine has been demonstrated to be protective against HEV in the general population and seems to be safe in pregnancy; however, its safety and efficacy in a large population of pregnant women remain to be determined. Conclusion: This review summarizes the current knowledge about HEV infection during pregnancy and focuses on the epidemiology, clinical manifestations, mechanisms underlying severe liver injury, and management and prevention of HEV infection during pregnancy. Considering that HEV infection during pregnancy may result in poor outcomes, screening for and monitoring HEV infection early in pregnancy should be taken into account. In addition, a better understanding of the pathogenesis will help to develop potential treatment strategies targeting HEV infection in pregnancy.

show abstract

“…In general, acute HEV infection is relatively asymptomatic or mildly symptomatic. However, acute icteric hepatitis is seen in almost 5%-30% of patients infected by the HEV[ 62 ]. Malaise, fever, body aches, nausea, and vomiting are characteristic symptoms observed through the 1-wk prodromal phase of acute icteric hepatitis, which is followed by the icteric phase lasting approximately 1 wk.…”

Section: Clinical Manifestations Of Hev Infectionsmentioning

confidence: 99%

“…Malaise, fever, body aches, nausea, and vomiting are characteristic symptoms observed through the 1-wk prodromal phase of acute icteric hepatitis, which is followed by the icteric phase lasting approximately 1 wk. It is marked by dark-colored urine and jaundice[ 62 ]. Then, the convalescent phase results in the resolution of icteric symptoms.…”

Section: Clinical Manifestations Of Hev Infectionsmentioning

confidence: 99%

Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment

Aslan

Balaban

2020

WJG

128

View full text Add to dashboard Cite

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.

show abstract

Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections

Cited by 102 publications

References 209 publications

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

Clinical Characteristics of Acute Hepatitis E and Their Correlation with HEV Genotype 3 Subtypes in Italy

Hepatitis E virus infection during pregnancy

Hepatitis E virus: Epidemiology, diagnosis, clinical manifestations, and treatment

Contact Info

Product

Resources

About