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Treatment of Chronic Hepatitis E in a Patient With HIV Infection

Harry R. Dalton, DPhil (Oxon); Frances E. Keane, FRCP; Richard Bendall, FRCPath; Joe Mathew, FRCPath; and Samreen Ijaz, PhD
[+] Article and Author Information

From European Centre for Environment & Human Health, Peninsula College of Medicine & Dentistry, Truro TR1 3HD, United Kingdom; Royal Cornwall Hospital Trust, Truro TR1 3LJ, United Kingdom; and Virus Reference Department, Microbiology Services-Colindale, Health Protection Agency, London NW9 5EQ, United Kingdom.


Acknowledgment: The authors thank Nassim Kamar and Janice Main for their advice about the treatment given to this patient.

Potential Conflicts of Interest: None disclosed.


Ann Intern Med. 2011;155(7):479-480. doi:10.7326/0003-4819-155-7-201110040-00017
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Figure.
Virologic, biochemical, and histologic variables and their response to treatment.

Top. The initial biopsy is cirrhotic, with parenchymal micronodules separated by broad bands of fibrous septa (arrowheads) in which there is a moderate mixed lymphocytic and neutrophilic inflammatory infiltrate associated with interphase hepatitis (arrow). There is an active hepatic component (without confluent necrosis) in parenchymal nodules with cholestatic features. The Hepatic Activity Index (5) was grade 9 (3.0.4.2), stage 6. Bottom. The posttreatment biopsy, stained with hematoxylin and eosin (scale bars = 200 µm), shows a significant decrease in portal and septal inflammation, minimal to no interface and acinar activity, and almost total resolution of the fibrotic process with occasional residual delicate portal–portal fibrous linkages (arrowhead). The Hepatic Activity Index was grade 3 (1.0.1.1), stage 4.

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