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Hepatitis E virus infection

Abstract

Hepatitis E virus (HEV) infection can lead to acute and chronic hepatitis as well as to extrahepatic manifestations such as neurological and renal disease; it is the most common cause of acute viral hepatitis worldwide. Four genotypes are responsible for most infection in humans, of which HEV genotypes 1 and 2 are obligate human pathogens and HEV genotypes 3 and 4 are mostly zoonotic. Until quite recently, HEV was considered to be mainly responsible for epidemics of acute hepatitis in developing regions owing to contamination of drinking water supplies with human faeces. However, HEV is increasingly being recognized as endemic in some developed regions. In this setting, infections occur through zoonotic transmission or contaminated blood products and can cause chronic hepatitis in immunocompromised individuals. HEV infections can be diagnosed by measuring anti-HEV antibodies, HEV RNA or viral capsid antigen in blood or stool. Although an effective HEV vaccine exists, it is only licensed for use in China. Acute hepatitis E is usually self-limiting and does not require specific treatment. Management of immunocompromised individuals involves lowering the dose of immunosuppressive drugs and/or treatment with the antiviral agent ribavirin.

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Figure 1: Worldwide presence of HEV genotypes.
Figure 2: HEV genome.
Figure 3: HEV life cycle.
Figure 4: HEV infection and hepatitis E.
Figure 5: Diagnostic algorithm for HEV infection.
Figure 6: Treatment algorithm for immunocompromised patients who received solid organ transplantation.

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Introduction (N.K. and H.R.D.); Epidemiology (R.A., H.W. and A.L.); Mechanisms/pathophysiology (N.P. and J.I.); Diagnosis, screening and prevention (J.I., H.R.D., A.L., R.A., H.W. and N.K.); Management (N.K. and H.W.); Quality of life (A.L.); Outlook (N.K. and H.R.D.); Overview of the Primer (N.K. and H.R.D.).

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Correspondence to Nassim Kamar.

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H.R.D. has received travel and accommodation costs and consultancy fees from GlaxoSmithKline, Roche and Wantai; he has received travel, accommodation and lecture fees from GFE Blut GmBh, Gilead and Merck; and he has received travel and accommodation fees from the Gates Foundation and Médecins sans Frontières and a grant from the British Medical Association. All other authors declare no competing interests related to this Primer.

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Kamar, N., Izopet, J., Pavio, N. et al. Hepatitis E virus infection. Nat Rev Dis Primers 3, 17086 (2017). https://doi.org/10.1038/nrdp.2017.86

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