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Antiviral therapy in chronic hepatitis E: a systematic review
A M Peters van Ton1, T J G Gevers1, J P H Drenth1
1Department of Gastroenterology & Hepatology, Radboud UMC, Nijmegen, The Netherlands.
Journal of Viral Hepatitis
|March 12, 2015
Summary
For immunocompromised patients with chronic Hepatitis E, ribavirin effectively eradicates the virus with manageable side effects. Peginterferon is not recommended due to transplant rejection risks.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic Hepatitis E infection poses a significant risk for immunocompromised individuals, potentially leading to severe liver disease and cirrhosis.
- Existing treatments like ribavirin and pegylated interferon-alpha have shown promise for viral eradication in isolated cases.
Purpose of the Study:
- To systematically review and compare the efficacy and safety of ribavirin versus pegylated interferon in treating chronic Hepatitis E.
- To determine the optimal antiviral treatment for immunocompromised patients with chronic Hepatitis E.
Main Methods:
- A systematic literature search was conducted across PubMed, Web of Science, and clinicaltrials.gov.
- Studies involving ribavirin or pegylated interferon for Hepatitis E treatment were included, focusing on sustained viral response (SVR) and safety.
- Twenty-four studies comprising 105 ribavirin-treated and 8 pegylated interferon-treated patients were analyzed.
Main Results:
- Ribavirin achieved a sustained viral response (SVR) in 64% of patients, with anemia as the primary side effect.
- Pegylated interferon resulted in SVR in only 2 out of 8 patients and led to acute transplant rejection in two cases.
- Ribavirin was generally well-tolerated, necessitating dose reduction in 28% of patients due to anemia.
Conclusions:
- Ribavirin monotherapy is an effective and safe treatment option for immunocompromised patients with chronic Hepatitis E.
- Pegylated interferon is associated with a risk of transplant rejection and is not recommended for this patient population.
- Ribavirin should be considered the primary antiviral treatment of choice for chronic Hepatitis E in immunocompromised individuals.
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