Abstract
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.
Highlights
The hepatitis E virus (HEV) is the leading cause of acute viral hepatitis worldwide
Neurological disorders have frequently been reported in patients with acute or chronic HEV infections and approximately 150 cases of neurological injury in HEV genotypes 1 (HEV1)-infected Asians and HEV3-infected Europeans have been described to date [49]
Both acute and chronic HEV infections can lead to kidney injuries and impaired renal function [66,67], but little is known about the underlying mechanisms
Summary
The hepatitis E virus (HEV) is the leading cause of acute viral hepatitis worldwide. HEV, which is mainly transmitted enterically, is responsible for outbreaks in developing countries and zoonotic cases in both developing and developed countries [1]. While most infections are asymptomatic, they can cause acute hepatitis, including severe forms in patients with pre-existing liver disease and in pregnant women living in developing countries. OORRFF44 hhaass bbeeeenn ffoouunndd oonnllyy iinn HHEEVV11.. HHEEVV bbeelloonnggss ttoo tthhee HHeeppeevviirriiddaaee ffaammiillyy,, wwhhiicchh hhaass ttwwoo ggeenneerraa:: PPiisscciihheeppeevviirruuss ((ccuutttthhrrooaatt ttrroouutt vviirruuss)) aanndd OOrrtthhoohheeppeevviriruuss(m(mamammmalailainananadndavaiavnianstrsatirnasi)nsw)itwhitfhoufrosuprecsipeesc(iAes–D(A) –(FDi)gu(Freig2u)r.eTh2)e. Two cases of patients infected with Orthohepevirus C HEV were reported recently, despite their 3g.eCnleitnicicdailffCeroeunrcsees ofrfoHmEoVthIenrfheuctmioann pathogenic strains [19,20]. Patients infected with HEV are usually middle-aged or elderly men (>55 years). In Europe, 5%–33% of patients infected with HEV3 or HEV4 develop symptoms, including jaundice [27,28,29]. A patient who had consumed camel meat and milk is believed to have developed a chronic HEV7 infection [16]. There have been no reports of HEV-infected transplant recipients developing fulminant hepatitis
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