Treatment Options for Hepatitis A and E: A Non-Systematic Review

Abstract

Hepatitis A and hepatitis E are relatively common causes of liver disease. Both viruses are mainly transmitted through the faecal–oral route and, consequently, most outbreaks occur in countries with poor sanitation. An important role of the immune response as the driver of liver injury is also shared by the two pathogens. For both the hepatitis A (HAV) and hepatitis E (HEV) viruses, the clinical manifestations of infection mainly consist of an acute disease with mild liver injury, which results in clinical and laboratory alterations that are self-limiting in most cases. However, severe acute disease or chronic, long-lasting manifestations may occur in vulnerable patients, such as pregnant women, immunocompromised individuals or those with pre-existing liver disease. Specifically, HAV infection rarely results in fulminant hepatitis, prolonged cholestasis, relapsing hepatitis and possibly autoimmune hepatitis triggered by the viral infection. Less common manifestations of HEV include extrahepatic disease, acute liver failure and chronic HEV infection with persistent viraemia. In this paper, we conduct a non-systematic review of the available literature to provide a comprehensive understanding of the state of the art. Treatment mainly consists of supportive measures, while the available evidence for aetiological treatment and additional agents in severe disease is limited in quantity and quality. However, several therapeutic approaches have been attempted: for HAV infection, corticosteroid therapy has shown outcome improvement, and molecules, such as AZD 1480, zinc chloride and heme oxygenase-1, have demonstrated a reduction in viral replication in vitro. As for HEV infection, therapeutic options mainly rely on the use of ribavirin, and some studies utilising pegylated interferon-alpha have shown conflicting results. While a vaccine for HAV is already available and has led to a significant reduction in the prevalence of the disease, several vaccines for HEV are currently being developed, with some already available in China, showing promising results.

Hepatitis E Virus: What More Do We Need to Know?

“…In 2010, a vaccine obtained from the ORF2 capsid protein of HEV genotype 1 was developed and licensed in China under the name Hecolin ® [ 133 ]. All HEV vaccine trials showed cross-genotype activity because HEV genotype 4 is the most common in China [ 134 ]. After nearly five years of vaccination, this vaccine provided long-term HEV protection in most previously seronegative patients [ 135 ].…”

Recent advances in hepatitis E virus research and the Japanese clinical practice guidelines for hepatitis E virus infection

“…[226][227][228] Severe acute illness may occur in vulnerable patients, such as pregnant women, immunocompromised persons, or those with pre-existing liver disease. 229 Ramsay et al…”

“…Host factors Older age 163,171 Genetic factors 192,194 Viral factors HEV viral load 174,195 HEV genotype 163,164,195 Nucleotide mutation 172,208 Other factors Existence of chronic liver disease 229,232 Existence of metabolic disease 242,250 Coinfection of HAV 244 Abbreviations: HAV, hepatitis A virus; HEV, hepatitis E virus. women and 41-year-old men) contracted HEV infection through blood transfusion.…”

“…� In older patients with chronic liver disease or metabolic disorders, close attention should be given to identify progression to severe hepatitis E. 163,171,229,232,250…”

Akute Virushepatitis

“…Hingegen zeigen > 75 % aller jungen Erwachsenen Symptome, die vom milden, anikterischen Krankheitsbild bis hin zur fulminanten Hepatitis reichen können. Die Erkrankung beginnt mit Übelkeit, Bauchschmerz, Fieber, Abgeschlagenheit, dunklem Urin und Ikterus [5]. Bei der klinischen Untersuchung findet man häufig ein druckschmerzhaftes Abdomen mit Hepatosplenomegalie.…”