Ribavirin treatment of acute and chronic hepatitis E: a single‐centre experience

Abstract

Ribavirin is a safe treatment option for HEV infections. However, the optimal dose of ribavirin for the treatment of chronic hepatitis E remains to be determined as treatment failure may occur.

A Mutation in the Hepatitis E Virus RNA Polymerase Promotes Its Replication and Associates With Ribavirin Treatment Failure in Organ Transplant Recipients

“…6 Ribavirin (RBV) monotherapy is the treatment-of-choice for most patients. 7,8 However, treatment failure has been observed, either as a partial response to ribavirin or viral recurrence after therapy cessation, and is possibly linked to dose reductions because of severe anemia in some cases. 7,8 We report on 15 solid-organ-transplant patients with chronic hepatitis E (11 with genotype 3c, 3 genotype 3f and 1 genotype 3e).…”

“…7,8 However, treatment failure has been observed, either as a partial response to ribavirin or viral recurrence after therapy cessation, and is possibly linked to dose reductions because of severe anemia in some cases. 7,8 We report on 15 solid-organ-transplant patients with chronic hepatitis E (11 with genotype 3c, 3 genotype 3f and 1 genotype 3e). RBV treatment was successful in all but 2 patients (both genotype 3c) who failed to clear the virus (13%, which is comparable to other studies reporting failure rates of 15-18%).…”

“…RBV treatment was successful in all but 2 patients (both genotype 3c) who failed to clear the virus (13%, which is comparable to other studies reporting failure rates of 15-18%). 7,8 The first patient was a male heart/kidney-recipient who was treated for 9 months and showed an initial decrease in viral RNA load upon initiation of RBV treatment but never became HEV RNA negative (i.e. below 1000 copies/mL, Figure 1A).…”

Hepatitis E virus replication and interferon responses in human placental cells

“…In apparent cases, mortality rates are estimated to be between 0.5% and 3%,9 leading to up to 70,000 deaths worldwide per year 10. Ribavirin (RBV) remains the treatment of choice in chronic infections and can be considered in fulminant cases 11, 12, 13. However, RBV administration should be carefully considered because of possible side effects,11 in particular anemia and treatment failure due to the selection of viral mutants with increased replication fitness 14, 15, 16.…”

Liver transplantation for acute liver failure because of genotype 3 hepatitis E virus infection

“…[5][6][7][8][9] On review of the literature, 9 patients with acute HEV have been treated with ribavirin for median duration of 7 weeks (10 days to 24 weeks) with median time to virological clearance of 4 weeks (3-8 weeks). It should be noted that ribavirin resistance in hepatitis E has also recently been reported.…”