Journal of Diagnostics Concepts & Practice >

2024 , Vol. 23 >Issue 01: 16 - 22

DOI: https://doi.org/10.16150/j.1671-2870.2024.01.003

Expert forum

Advances in the diagnosis and treatment of chronic hepatitis E

Expand
  • Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2023-09-10

  Online published: 2024-05-30

Fold

Abstract

According to the World Health Organization, hepatitis E virus (HEV) may cause approximately 20 million new infections annually in the world, and potentially lead to more than 3 million cases of acute hepatitis. Prevalence of viral hepatitis E is high in China, and the number of newly-diagnosed hepatitis E cases has exceeded that of newly-diagnosed hepatitis A cases. The reported incidence rate of hepatitis E increased from 1.77/100 000 in 2010 to 2.02/100 000 in 2019. HEV infections in China are mainly due to foodborne infections. Chronic HEV infection is defined as the detection of HEV RNA in blood or stools for more than 3 months. It often occurs in immunocompromised populations and may lead to rapid progression of liver fibrosis and cirrhosis in patients. In China, HEV genotype 4 is the predominant genotype, so chronic hepatitis E patients in China are also mainly infected with HEV genotype 4. The diagnosis of HEV infection is mainly based on specific HEV antibodies or pathogenic indicators. HEV infection screening should focus on patients with underlying liver diseases, women of childbearing age and the elderly, as well as immunocompromised patients (such as organ transplant patients, patients with blood tumor, HIV-infected individuals), etc. There are still many problems in the diagnosis and treatment of HEV, including the unclear risk factors for rapid progression of liver fibrosis in patients with chronic hepatitis E, and the unclear mechanisms on that elderly men and pregnant women are prone to severe cases of HEV infection.The screening of anti-HEV drugs is mostly based on in vitro cell models, which are still in the pre-clinical stage. In the future, research should focus on the pathogenesis of hepatitis E, promoting intersection, integration, and transformation of basic research and clinical research, which may provide impetus for the better diagnosis and treatment of chronic hepatitis E.

Key words： Hepatitis E virus; Chronic hepatitis E; HEV genotype 4

Cite this article

LU Jie, XIE Qing . Advances in the diagnosis and treatment of chronic hepatitis E[J]. Journal of Diagnostics Concepts & Practice, 2024 , 23(01) : 16 -22 . DOI: 10.16150/j.1671-2870.2024.01.003

References

[1] World Health Organization. Hepatitis E[EB/OL]. 2023-07-23[2024-04-22]. https://www.who.int/news-room/fact-sheets/detail/hepatitis-e.
[2] 2010年全国法定传染病疫情概况[EB/OL]. 2011-02-12[2024-04-25]. https://www.gov.cn/gzdt/2011-02/12/content_1801989.htm.
[3] 2019年全国法定传染病疫情概况[EB/OL]. 2020-04-20[2024-04-25]. http://www.nhc.gov.cn/jkj/s3578/202004/b1519e1bc1a944fc8ec176db600f68d1.shtml.
[4] 中华医学会肝病学分会. 戊型肝炎防治共识[J]. 中华肝脏病杂志, 2022, 30(8):820-831.
  Chinese Society of Hepatology, Chinese Medical Association. Consensus on prevention and treatment of hepatitis E[J]. Chin J Hepatol, 2022, 30(8):820-831.
[5] NIMGAONKAR I, DING Q, SCHWARTZ R E, et al. Hepatitis E virus: advances and challenges[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(2):96-110.
[6] SRIDHAR S, YIP C C Y, WU S, et al. Rat Hepatitis E Virus as Cause of Persistent Hepatitis after Liver Transplant[J]. Emerg Infect Dis, 2018, 24(12):2241-2250.
[7] AYE T T, UCHIDA T, MA X Z, et al. Complete nucleotide sequence of a hepatitis E virus isolated from the Xinjiang epidemic (1986-1988) of China[J]. Nucleic Acids Res, 1992, 20(13):3512.
[8] LIU P, LI L, WANG L, et al. Phylogenetic analysis of 626 hepatitis E virus (HEV) isolates from humans and animals in China (1986-2011) showing genotype diversity and zoonotic transmission[J]. Infect Genet Evol, 2012, 12(2):428-434.
[9] MA Z, DE MAN R A, KAMAR N, PAN Q. Chronic hepatitis E: Advancing research and patient care[J]. J Hepatol, 2022, 77(4):1109-1123.
[10] KRAIN L J, ATWELL J E, NELSON K E, et al. Fetal and neonatal health consequences of vertically transmitted hepatitis E virus infection[J]. Am J Trop Med Hyg, 2014, 90(2):365-370.
[11] 中国戊型肝炎研究协助组(CCSHE), 中国医师协会感染科医师分会, 国家感染性疾病临床医学研究中心. 中国戊型病毒性肝炎院内筛查管理流程专家共识(2023年版)[J]. 临床肝胆病杂志, 2023, 39(4):785-794.
  Chinese Consortium for the Study of Hepatitis E (CCSHE), Chinese Physician Association for Infectious Disease, National Clinical Research Center for Infectious Diseases. Expert consensus on the process of in-hospital screening and management of viral hepatitis E in China (2023)[J]. J Clin Hepatol, 2023, 39(4):785-794.
[12] TAMURA A, SHIMIZU Y K, TANAKA T, et al. Persistent infection of hepatitis E virus transmitted by blood transfusion in a patient with T-cell lymphoma[J]. Hepatol Res, 2007, 37(2):113-120.
[13] KAMAR N, SELVES J, MANSUY J M, et al. Hepatitis E virus and chronic hepatitis in organ-transplant recipients[J]. N Engl J Med, 2008, 358(8):811-817.
[14] DALTON H R, BENDALL R P, KEANE F E, et al. Persistent carriage of hepatitis E virus in patients with HIV infection[J]. N Engl J Med, 2009, 361(10):1025-1027.
[15] KUNIHOLM M H, ONG E, HOGEMA B M, et al. Acute and Chronic Hepatitis E Virus Infection in Human Immunodeficiency Virus-Infected U.S. Women[J]. Hepatology, 2016, 63(3):712-720.
[16] FRATICELLI P, BAGNARELLI P, TARANTINO G, et al. Chronic hepatitis E in a patient treated with rituximab and mycophenolate mofetil for Sj?gren's syndrome[J]. Rheumatology (Oxford), 2016, 55(12):2275-2277.
[17] VAN BIJNEN S T, LEDEBOER M, MARTENS H A. Chronic hepatitis E in a patient with rheumatoid arthritis treated with adalimumab and methotrexate[J]. Rheumatology (Oxford), 2017, 56(3):497-498.
[18] LAMPEJO T, CURTIS C, IJAZ S, et al. Nosocomial transmission of hepatitis E virus and development of chronic infection: The wider impact of COVID-19[J]. J Clin Virol, 2022,148:105083.
[19] YING D, NIU W, CHEN Y, et al. Case Report: chronic hepatitis E virus Infection in an individual without evidence for immune deficiency[J]. Front Immunol, 2023, 14:1183859.
[20] FUJIWARA S, YOKOKAWA Y, MORINO K, et al. Chronic hepatitis E: a review of the literature[J]. J Viral Hepat, 2012, 21(2):78-89.
[21] SOORYANARAIN H, MENG X J. Swine hepatitis E virus: Cross-species infection, pork safety and chronic infection[J]. Virus Res, 2020, 284:197985.
[22] KAMAR N, PISCHKE S. Acute and persistent hepatitis E virus genotype 3 and 4 infection: clinical features, pathogenesis, and treatment[J]. Cold Spring Harb Perspect Med, 2019, 9(7):a031872.
[23] NGUYEN H T, TORIAN U, FAULK K, et al. A naturally occurring human/hepatitis E recombinant virus predominates in serum but not in faeces of a chronic hepatitis E patient and has a growth advantage in cell culture[J]. J Gen Virol, 2012, 93(Pt 3):526-530.
[24] SHUKLA P, NGUYEN H T, FAULK K, et al. Adaptation of a genotype 3 hepatitis E virus to efficient growth in cell culture depends on an inserted human gene segment acquired by recombination[J]. J Virol, 2012, 86(10):5697-5707.
[25] MU?OZ-CHIMENO M, CENALMOR A, GARCIA-LUGO M A, et al. Proline-Rich Hypervariable Region of Hepatitis E Virus: Arranging the Disorder[J]. Microorga-nisms, 2020, 8(9):1417.
[26] GENG Y, ZHANG H, HUANG W, et al. Persistent hepatitis e virus genotype 4 infection in a child with acute lymphoblastic leukemia[J]. Hepat Mon, 2014. 14(1):e15618.
[27] WANG Y, CHEN G, PAN Q, et al. Chronic hepatitis E in a renal transplant recipient: the first report of genotype 4 hepatitis e virus caused chronic infection in organ reci-pient[J]. Gastroenterology, 2018, 154(4):1199-1201.
[28] LEE G H, TAN B H, TEO E C, et al. Chronic infection with camelid hepatitis e virus in a liver transplant recipient who regularly consumes camel meat and milk[J]. Gastroenterology, 2016, 150(2):355-7.e3.
[29] SRIDHAR S, YIP C C Y, LO K H Y, et al. Hepatitis E virus species c infection in humans, Hong Kong[J]. Clin Infect Dis, 2022, 75(2):288-296.
[30] KAMAR N, IZOPET J, CINTAS P, et al. Hepatitis E virus-induced neurological symptoms in a kidney-transplant patient with chronic hepatitis[J]. Am J Transplant, 2010, 10(5):1321-1324.
[31] KAMAR N, BENDALL R P, PERON J M, et al. Hepatitis E virus and neurologic disorders[J]. Emerg Infect Dis, 2011, 17(2):173-179.
[32] KAMAR N, MANSUY J M, COINTAULT O, et al. Hepatitis E virus-related cirrhosis in kidney- and kidney-pancreas-transplant recipients[J]. Am J Transplant, 2008, 8(8):1744-1748.
[33] KAMAR N, GARROUSTE C, HAAGSMA E B, et al. Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants[J]. Gastroenterology, 2011, 140(5):1481-1489.
[34] CHEN Z, WEI J, JIANG L, et al. Case Report: Chronic hepatitis E in a hematopoietic stem cell transplant reci-pient: The first report of hepatitis E virus genotype 4 causing chronic infection in a non-solid organ recipient[J]. Front Immunol, 2022, 13:954697.
[35] GéROLAMI R, MOAL V, PICARD C, et al. Hepatitis E virus as an emerging cause of chronic liver disease in organ transplant recipients[J]. J Hepatol, 2009, 50(3):622-624.
[36] European Association for the Study of the Liver. EASL Clinical Practice Guidelines on hepatitis E virus infection[J]. J Hepatol, 2018, 68(6):1256-1271.
[37] YING D, HE Q, TIAN W, et al. Urine is a viral antigen reservoir in hepatitis E virus infection[J]. Hepatology, 2023, 77(5):1722-1734.
[38] GALANTE A, PISCHKE S, POLYWKA S, et al. Relevance of chronic hepatitis E in liver transplant recipients: a real-life setting[J]. Transpl Infect Dis, 2015, 17(4):617-622.
[39] DALTON H R, KEANE F E, BENDALL R, et al. Treatment of chronic hepatitis E in a patient with HIV infection[J]. Ann Intern Med, 2011, 155(7):479-480.
[40] KAMAR N, ROSTAING L, ABRAVANEL F, et al. Pegylated interferon-alpha for treating chronic hepatitis E virus infection after liver transplantation[J]. Clin Infect Dis, 2010, 50(5):e30-e33.
[41] KAMAR N, ROSTAING L, ABRAVANEL F, et al. Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection[J]. Gastroenterology, 2010, 139(5):1612-1618.
[42] PISCHKE S, STIEFEL P, FRANZ B, et al. Chronic hepatitis e in heart transplant recipients[J]. Am J Transplant, 2012, 12(11):3128-3133.
[43] CHAILLON A, SIRINELLI A, DE MURET A, et al. Sustained virologic response with ribavirin in chronic hepatitis E virus infection in heart transplantation[J]. J Heart Lung Transplant, 2011, 30(7):841-843.
[44] RIEZEBOS-BRILMAN A, PUCHHAMMER-ST?CKL E, VAN DER WEIDE HY, et al. Chronic hepatitis E infection in lung transplant recipients[J]. J Heart Lung Transplant, 2013, 32(3):341-346.
[45] MALLET V, NICAND E, SULTANIK P, et al. Brief communication: case reports of ribavirin treatment for chronic hepatitis E[J]. Ann Intern Med, 2010, 153(2):85-89.
[46] KAMAR N, IZOPET J, TRIPON S, et al. Ribavirin for chronic hepatitis E virus infection in transplant recipients[J]. N Engl J Med, 2014, 370(12):1111-1120.
[47] KAMAR N, ABRAVANEL F, SELVES J, et al. Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation[J]. Transplantation, 2010, 89(3):353-360.
[48] WANG Y, ZHOU X, DEBING Y, et al. Calcineurin inhibitors stimulate and mycophenolic acid inhibits replication of hepatitis E virus[J]. Gastroenterology, 2014, 146(7):1775-1783.
[49] MCPHERSON S, ELSHARKAWY AM, ANKCORN M, et al. Summary of the British Transplantation Society UK Guidelines for hepatitis E and solid organ transplantation[J]. Transplantation, 2018, 102(1):15-20.
[50] ZHANG F, XU L D, ZHANG Q, et al. Targeting proteostasis of the HEV replicase to combat infection in preclinical models[J]. J Hepatol, 2023, 78(4):704-716.
[51] QU C, LI Y, LI Y, et al. FDA-drug screening identifies deptropine inhibiting hepatitis E virus involving the NF-κB-RIPK1-caspase axis[J]. Antiviral Res, 2019, 170:104588.
[52] LI Y, LI P, HE Q, et al. Niclosamide inhibits hepatitis E virus through suppression of NF-kappaB signalling[J]. Antiviral Res, 2022, 197:105228.
[53] GUO H, LIU D, LIU K, et al. Drug repurposing screen identifies vidofludimus calcium and pyrazofurin as novel chemical entities for the development of hepatitis E interventions[J]. Virol Sin, 2024, 39(1):123-133.
[54] ZHU F C, ZHANG J, ZHANG X F, et al. Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial[J]. Lancet, 2010, 376(9744):895-902.
[55] WEN G P, HE L, TANG Z M, et al. Quantitative evaluation of protective antibody response induced by hepatitis E vaccine in humans[J]. Nat Commun, 2020, 11(1):3971.
Options
Outlines

/

〈 〉