Elsevier

Journal of Clinical Virology

Volume 74, January 2016, Pages 82-87
Journal of Clinical Virology

Hepatitis E virus genotype 3 infection in a tertiary referral center in the Netherlands: Clinical relevance and impact on patient morbidity

https://doi.org/10.1016/j.jcv.2015.11.038Get rights and content

Highlights

  • Chronic infections only occur in immunocompromised patients.

  • Patients with pre-existent liver diseases are at risk for complications and death.

  • Chronic infections occur if viraemia persists for three months of watchful waiting.

  • Ribavirin treatment is effective in the shortening of infection duration.

Abstract

Background

Hepatitis E virus (HEV) genotype 3 infections can have important clinical consequences.

Objectives

To evaluate patients at risk and the effect of treatment strategies, we studied the clinical course and treatment outcome in patients diagnosed with HEV viremia in our hospital.

Study design

Between January 2008 and March 2015 we included all patients with HEV genotype 3 (HEV-3) infections diagnosed by means of quantitative real-time reverse transcription-polymerase chain reaction test (RT-PCR). Clinical data were evaluated retrospectively.

Results

In total 79 patients were included. Forty-nine patients (62%) were male, median age of all patients was 52 years (range 13–79). Sixty-one (77%) patients were immunocompromised. Three patients (3.8%) had only transient viremia, forty-three (54.5%) cleared the infection within six months and twenty-six (32.9%) developed chronic infection. Five patients (6.3%) were lost to follow-up. All patients developing chronic infection were immunocompromised. Overall, thirteen (16%) patients within this cohort died. Three patients had pre-existent liver diseases and died of liver-related causes. Time between diagnosis and death was shorter for patients with pre-existent liver diseases (p = 0.03). Twenty-eight percent of patients on immunosuppressive medication achieved viral clearance after reducing the dose of immunosuppressive therapy. Thirty patients (38.0%) were treated with off-label ribavirin in which 25 (83.3%) a sustained viral response has been documented.

Conclusion

HEV genotype 3 viremia mainly presents in patients with underlying chronic liver diseases or an impaired immune system. Patients with pre-existent liver diseases are at high risk for complications and even death. The off-label use of ribavirin can cure HEV infection.

Section snippets

Background

Chronic HEV-3 infections are increasingly being reported in immunocompromised patients.

Objectives

To evaluate patients at risk and the effect of treatment strategies, we studied the clinical course, therapeutic interventions and treatment outcome in all patients diagnosed with HEV-3 viremia in our hospital.

Study design

This retrospective cohort-study was conducted at the Erasmus MC, University Medical Center Rotterdam, a tertiary referral and transplant center. We included all patients who tested positive for HEV RNA genotype 3 in serum or blood between January 2008 and March 2015.

Patients were tested prospectively for HEV RNA during yearly routine checkup after transplantation or in case of unexplained elevated liver enzymes.

Patients were included if they tested positive for HEV-3 RNA in serum or blood.

Results

A total of 80 patients tested positive for HEV RNA in serum. In all but one patient HEV-3 was detected so a total of 79 patients were included. Thirty-two patients (40.5%) were tested in the context of screening before or after transplantation, 5 (6.3%) were suspected of graft versus host disease (GvHD) and 42 (53.2%) were tested in case of unexplained hepatitis. Forty-nine patients were male (62.0%) and median age was 52 years (13–79). In total 61 patients (77.2%) were immunocompromised. Three

Discussion

We describe the clinical characteristics and outcome of HEV-3 infections in a tertiary referral hospital based population in the Netherlands and show that HEV can cause significant morbidity and contribute to mortality in patients. The off label use of ribavirin therapy provides viral clearance within a median of two months. To the best of our knowledge this retrospective single center study is the largest series so far to evaluate the clinical course and treatment outcome of HEV infection in

Conflicts of interest

None.

Funding

None.

Competing interests

None.

Ethical approval

Obtained from the Instutions Review Board of Erasmus MC, Rotterdam, the Netherlands.

Acknowledgements

None.

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