Hepatitis E virus infection: considerations for immunologists and rheumatologists

Area of Science:

• Hepatology
• Virology
• Rheumatology

Background:

• Hepatitis E virus (HEV) is a globally prevalent pathogen posing risks to immunocompromised individuals.
• Patients with rheumatic diseases are particularly vulnerable to HEV infection, presenting management challenges.
• HEV prevalence may be underestimated, necessitating increased clinical awareness.

Purpose of the Study:

• To provide a comprehensive summary of current HEV knowledge.
• To focus on HEV information applicable to rheumatology practice.
• To highlight diagnostic and treatment challenges of HEV in immunocompromised patients.

Main Methods:

• Systematic literature review using Scopus, PubMed, and Web of Science.
• Keywords included: hepatitis E virus, HEV, rheumatology, connective tissue disease.
• Analysis of current knowledge on HEV epidemiology, diagnosis, and management.

Main Results:

• HEV genotype 3 is common in Europe, linked to consuming undercooked pork or wild boar.
• While often self-limiting, HEV can cause chronic infections and extrahepatic manifestations, particularly neurological ones, in immunosuppressed individuals.
• Diagnosis can be challenging, and treatment is typically not required for acute cases, though immunosuppression reduction or ribavirin may be considered for chronic or severe cases.

Conclusions:

• HEV infection represents a significant risk for immunocompromised patients, including those with rheumatic diseases.
• Further research is needed to elucidate HEV infection mechanisms and optimize treatment strategies.
• Clinicians should consider HEV in the differential diagnosis of immunocompromised patients, even without classic symptoms.