Vincent Mallet, MD, PhD; Elisabeth Nicand, MD; Philippe Sultanik, MD; Catherine Chakvetadze, MD; Sophie Tessé, PhD; Eric Thervet, MD, PhD; Luc Mouthon, MD, PhD; Philippe Sogni, MD, PhD; Stanislas Pol, MD, PhD
There is currently no accepted treatment of chronic hepatitis E virus (HEV) infection.
To report 2 patients in whom ribavirin therapy seemed to alter the natural history of chronic HEV infection.
Hepatology unit of a tertiary care center in France.
A kidney and pancreas transplant recipient and a patient with idiopathic CD4+ T lymphocytopenia, both with biopsy-proven chronic HEV infection.
Patients received oral ribavirin, 12 mg/kg of body weight daily for 12 weeks.
Liver function tests, detection of HEV RNA (viremia and stool shedding) by reverse transcriptase polymerase chain reaction, and anti-HEV IgM and IgG antibodies.
Both patients had normalized liver function test results after 2 weeks of treatment and cleared HEV after 4 weeks of treatment. Hepatitis E virus RNA remained undetectable in the serum and stools throughout follow-up (3 months and 2 months for the first and second patient, respectively). Side effects were considered mild.
Given the relatively short follow-up, the achievement of HEV eradication could not be claimed.
Ribavirin is a potentially effective treatment of HEV infection and should be evaluated in patients with chronic HEV infection.
Chronic hepatitis E virus (HEV) infection is an emerging infectious disease in immunocompromised patients. Therapy has been limited to supportive measures.
In 2 patients with chronic HEV infection who received treatment with ribavirin, liver enzyme levels normalized and the virus was no longer detected in blood and stool. These results persisted after treatment was stopped.
Longer follow-up of these 2 patients is needed. Controlled trials of ribavirin treatment in patients with chronic HEV infection are needed to determine efficacy. In addition, ribavirin is contraindicated in pregnancy (U.S. Food and Drug Administration category X drug).
Antiviral therapy of chronic HEV infection may be possible.
The graph plots the number of times the ALT level was above the ULN, by date. Genome amplifications of hepatitis B virus and hepatitis C virus were both negative. Other causes of chronic liver disease, including hemochromatosis, autoimmune hepatitis, α1-antitrypsin deficiency, and Wilson disease, were also ruled out. For the serologic and RT-PCR tests, a plus symbol indicates a positive result and a minus symbol indicates a negative result. ALT = alanine aminotransferase; ELISA = enzyme-linked immunosorbent assay; HEV = hepatitis E virus; RT-PCR = reverse transcriptase polymerase chain reaction; ULN = upper limit of normal.
The graph plots the number of times the ALT level was above the ULN, by date. Genome amplifications of hepatitis B virus and hepatitis C virus were both negative. Other causes of chronic liver disease, including hemochromatosis, autoimmune hepatitis, α1-antitrypsin deficiency, and Wilson disease, were also ruled out. For the serologic and RT-PCR tests, a plus symbol indicates a positive result, a minus symbol indicates a negative result, and a plus/minus symbol indicates a positive test result at the limit of detection of the RT-PCR assay. ALT = alanine aminotransferase; ELISA = enzyme-linked immunosorbent assay; HEV = hepatitis E virus; RT-PCR = reverse transcriptase polymerase chain reaction; ULN = upper limit of normal.
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Mallet V, Nicand E, Sultanik P, Chakvetadze C, Tessé S, Thervet E, et al. Brief Communication: Case Reports of Ribavirin Treatment for Chronic Hepatitis E. Ann Intern Med. ;153:85–89. doi: 10.7326/0003-4819-153-2-201007200-00257
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Published: Ann Intern Med. 2010;153(2):85-89.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease.
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