scholarly journals Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections

2020 ◽  
Vol 9 (2) ◽  
pp. 331 ◽  
Author(s):  
Sébastien Lhomme ◽  
Olivier Marion ◽  
Florence Abravanel ◽  
Jacques Izopet ◽  
Nassim Kamar
Keyword(s):  
Hepatitis E Virus ◽  
Hematologic Malignancy ◽  
Antiviral Treatment ◽  
Clinical Manifestations ◽  
Hepatitis E ◽  
Immunosuppressive Drugs ◽  
New Drugs ◽  
Renal Diseases ◽  
Solid Organ ◽  
Immunocompromised Patients

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis throughout the world. Most infections are acute but they can become chronic in immunocompromised patients, such as solid organ transplant patients, patients with hematologic malignancy undergoing chemotherapy and those with a human immunodeficiency virus (HIV) infection. Extra-hepatic manifestations, especially neurological and renal diseases, have also been described. To date, four main genotypes of HEV (HEV1-4) were described. HEV1 and HEV2 only infect humans, while HEV3 and HEV4 can infect both humans and animals, like pigs, wild boar, deer and rabbits. The real epidemiology of HEV has been underestimated because most infections are asymptomatic. This review focuses on the recent advances in our understanding of the pathophysiology of acute HEV infections, including severe hepatitis in patients with pre-existing liver disease and pregnant women. It also examines the mechanisms leading to chronic infection in immunocompromised patients and extra-hepatic manifestations. Acute infections are usually self-limiting and do not require antiviral treatment. Conversely, a chronic HEV infection can be cleared by decreasing the dose of immunosuppressive drugs or by treating with ribavirin for 3 months. Nevertheless, new drugs are needed for those cases in which ribavirin treatment fails.

scholarly journals Hepatitis E Virus Quasispecies and the Outcome of Acute Hepatitis E in Solid-Organ Transplant Patients

2012 ◽  
Vol 86 (18) ◽  
pp. 10006-10014 ◽  
Author(s):  
Sebastien Lhomme ◽  
Florence Abravanel ◽  
Martine Dubois ◽  
Karine Sandres-Saune ◽  
Lionel Rostaing ◽  
...  
Keyword(s):  
Liver Fibrosis ◽  
Acute Hepatitis ◽  
Hepatitis E Virus ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Solid Organ Transplant ◽  
First Year ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
Serum Concentrations

Hepatitis E virus (HEV) infections are responsible for chronic hepatitis in immunocompromised patients, and this can evolve to cirrhosis. Like all RNA viruses, HEV exists as a mixture of heterogeneous viruses defining quasispecies. The relationship between the genetic heterogeneity described as a quasispecies, cytokine secretion, and the outcome of acute hepatitis in immunocompromised patients remains to be elucidated. We cloned and sequenced the region encoding the M and P capsid domains of HEV from eight solid-organ transplant (SOT) patients with acute HEV infection who subsequently cleared the virus and from eight SOT patients whose infection became chronic. We analyzed the cytokines and chemokines in the sera of these SOT patients by multianalyte profiling. The nucleotide sequence entropy and genetic distances were greater in patients whose infections became chronic. A lowerKa/Ksratio was associated with the persistence of HEV. The patients who developed chronic infection had lower serum concentrations of interleukin-1 (IL-1) receptor antagonist and soluble IL-2 receptor. Increased concentrations of the chemokines implicated in leukocyte recruitment to the liver were associated with persistent infection. Those patients with chronic HEV infection and progressing liver fibrosis had less quasispecies diversification during the first year than patients without liver fibrosis progression. Great quasispecies heterogeneity, a weak inflammatory response, and high serum concentrations of the chemokines involved in leukocyte recruitment to the liver in the acute phase were associated with persistent HEV infection. Slow quasispecies diversification during the first year was associated with rapidly developing liver fibrosis.

scholarly journals Hepatitis E Virus Immunopathogenesis

Pathogens ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1180
Author(s):  
Kush Kumar Yadav ◽  
Scott P. Kenney
Keyword(s):  
Hepatitis E Virus ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Oral Route ◽  
Solid Organ ◽  
Immunocompromised Patients ◽  
In Vivo Models ◽  
Transplant Patients

Hepatitis E virus is an important emerging pathogen producing a lethal impact on the pregnant population and immunocompromised patients. Starting in 1983, it has been described as the cause for acute hepatitis transmitted via the fecal–oral route. However, zoonotic and blood transfusion transmission of HEV have been reported in the past few decades, leading to the detailed research of HEV pathogenesis. The reason behind HEV being highly virulent to the pregnant population particularly during the third trimester, leading to maternal and fetal death, remains unknown. Various host factors (immunological, nutritional, hormonal) and viral factors have been studied to define the key determinants assisting HEV to be virulent in pregnant and immunocompromised patients. Similarly, chronic hepatitis is seen particularly in solid organ transplant patients, resulting in fatal conditions. This review describes recent advances in the immunopathophysiology of HEV infections in general, pregnant, and immunocompromised populations, and further elucidates the in vitro and in vivo models utilized to understand HEV pathogenesis.

scholarly journals Hepatitis E Virus and rheumatic diseases: what do rheumatologists need to know?

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Salvatore Di Bartolomeo ◽  
Francesco Carubbi ◽  
Paola Cipriani
Keyword(s):  
Rheumatic Diseases ◽  
Hepatitis E Virus ◽  
Rapid Development ◽  
Hepatitis E ◽  
Immunosuppressive Drugs ◽  
Main Body ◽  
Solid Organ ◽  
Chronic Infections ◽  
Rheumatic Manifestations ◽  
The Impact

Abstract Background Hepatitis E virus (HEV) represents the most common cause of acute hepatitis and jaundice in the world. About 2 million of infection cases occur each year in Europe, mainly as autochthonous anthropozoonosis, and HEV can be transmitted through undercooked pork meat. This infection has been linked to various extra-hepatic manifestations, while chronic infections with a rapid development of liver failure have been described in heavily immunosuppressed patients undergoing solid organ transplantations (SOTs), in patients with hematological diseases or with immunodeficiency virus infection. Main body of abstract The purpose of this review article is to describe rheumatic manifestations related to HEV infection and their implications for rheumatologists in the daily clinical practice. Despite recent accumulating literature in this field, little is known about the course of the infection in patients with rheumatic diseases (RDs) and about the impact of immunosuppressive drugs. Moreover, HEV infection can mimic RDs’ manifestations or drugs toxicity. Specific guidelines on management are lacking and the majority of data are referred to SOTs receivers. Conclusions More studies are needed to better understand the real impact of HEV infection in patients with RDs, regarding both clinical outcomes and their management.

scholarly journals Implications of Hepatitis E Virus in Blood Transfusions, Hemodialysis, and Solid Organ Transplants

Medicina ◽  
2020 ◽  
Vol 56 (5) ◽  
pp. 206
Author(s):  
Essam M. Janahi ◽  
Saba F. D. Parkar ◽  
Sakina Mustafa ◽  
Zaki M. Eisa
Keyword(s):  
Chronic Hepatitis ◽  
Blood Transfusion ◽  
Hepatitis E Virus ◽  
Hepatitis E ◽  
Immunosuppressive Drugs ◽  
Hemodialysis Patients ◽  
Solid Organ ◽  
Organ Transplants ◽  
Seroprevalence Data ◽  
Epidemiological Characteristics

Hepatitis E Virus (HEV) is emerging as the primary cause of acute viral hepatitis in humans. The virus is commonly transmitted by the fecal–oral route via contaminated water in endemic regions or through the consumption of inadequately cooked swine products or game meats in industrialized regions. HEV genotypes 1 and 2 are predominantly associated with waterborne transmission in developing countries, whereas HEV3 and HEV4 are mainly zoonotically transmitted in industrialized countries. Seroprevalence in populations determined by detecting anti-HEV antibodies and serum HEV RNA is commonly used to analyze the presence of HEV. Although HEV RNA-based detection is now standardized, there is a lack of agreement between the assaying methods used for gathering seroprevalence data. Since 2004, HEV has been considered as a transmissible infectious agent through blood transfusion. Recent seroprevalence studies in European countries indicate an underestimated risk for blood transfusion and hence warrant testing the blood supply. HEV infection is usually self-limiting and spontaneously cleared. However, in about 60% of recipients of solid organ transplants, HEV progresses to chronic hepatitis. Immunosuppressive drugs such as tacrolimus are a major cause of chronic hepatitis and reducing its dosage results in viral clearance in about 30% of patients. In hemodialysis patients, the parenteral route is implicated as an important mechanism of transmission. In this review, we explore the clinical and epidemiological characteristics of various HEV genotypes in blood donors, hemodialysis patients, and transplant recipients.

scholarly journals Hepatitis E Virus Infection among Solid Organ Transplant Recipients, the Netherlands

2012 ◽  
Vol 18 (5) ◽  
pp. 869-872 ◽  
Author(s):  
Suzan D. Pas ◽  
Rob A. de Man ◽  
Claudia Mulders ◽  
Aggie H.M.M. Balk ◽  
Peter T.W. van Hal ◽  
...  
Keyword(s):  
Virus Infection ◽  
The Netherlands ◽  
Hepatitis E Virus ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Performance of a new rapid test for detecting anti-hepatitis E virus immunoglobulin M in immunocompetent and immunocompromised patients

2015 ◽  
Vol 70 ◽  
pp. 101-104 ◽  
Author(s):  
Florence Abravanel ◽  
Sébastien Lhomme ◽  
Sabine Chapuy-Regaud ◽  
Jean-Marie Peron ◽  
Laurent Alric ◽  
...  
Keyword(s):  
Hepatitis E Virus ◽  
Rapid Test ◽  
Hepatitis E ◽  
Immunoglobulin M ◽  
Immunocompromised Patients

scholarly journals Beyond the Usual Suspects: Hepatitis E Virus and Its Implications in Hepatocellular Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5867
Author(s):  
Mara Klöhn ◽  
Jil Alexandra Schrader ◽  
Yannick Brüggemann ◽  
Daniel Todt ◽  
Eike Steinmann
Keyword(s):  
Hepatocellular Carcinoma ◽  
Viral Hepatitis ◽  
Hepatitis E Virus ◽  
Clinical Evidence ◽  
Hepatitis E ◽  
Clinical Spectrum ◽  
Immunocompromised Patients ◽  
Virus Infections ◽  
The Relationship ◽  
Liver Infection

Hepatitis E virus infections are the leading cause of viral hepatitis in humans, contributing to an estimated 3.3 million symptomatic cases and almost 44,000 deaths annually. Recently, HEV infections have been found to result in chronic liver infection and cirrhosis in severely immunocompromised patients, suggesting the possibility of HEV-induced hepatocarcinogenesis. While HEV-associated formation of HCC has rarely been reported, the expansion of HEV’s clinical spectrum and the increasing evidence of chronic HEV infections raise questions about the connection between HEV and HCC. The present review summarizes current clinical evidence of the relationship between HEV and HCC and discusses mechanisms of virus-induced HCC development with regard to HEV pathogenesis. We further elucidate why the development of HEV-induced hepatocellular carcinoma has so rarely been observed and provide an outlook on possible experimental set-ups to study the relationship between HEV and HCC formation.

Hepatitis E virus-associated cryoglobulinemia in solid-organ-transplant recipients

2018 ◽  
Vol 38 (12) ◽  
pp. 2178-2189 ◽  
Author(s):  
Olivier Marion ◽  
Florence Abravanel ◽  
Arnaud Del Bello ◽  
Laure Esposito ◽  
Sebastien Lhomme ◽  
...  
Keyword(s):  
Hepatitis E Virus ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients
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