An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant Patients

Transplantation. 2015 Oct;99(10):2124-31. doi: 10.1097/TP.0000000000000850.


Background: Ribavirin is efficient at treating chronic hepatitis E virus infection in solid-organ transplant patients. However, the early kinetics of viral replication under therapy and the impact of immunosuppressant regimens on viral replication are unknown: thus, determining the aim of our study.

Methods: Thirty-five patients with a solid-organ transplant and chronic hepatitis E virus infection were given ribavirin for 3 months. The hepatitis E virus (HEV) RNA concentrations were determined before treatment, at days 7, 15, and 21 and at months 1, 2, and 3 during therapy and after ribavirin cessation.

Results: A sustained virological response (SVR) occurred in 63%. Decreased viral concentration within the first week post-ribavirin therapy was an independent predictive factor for SVR, and a decreased HEV concentration of 0.5 log copies/mL or greater had an 88% positive predictive value. No correlation between ribavirin trough level on day 7 or at month 2 with a virological response or an SVR was observed. Before therapy, HEV RNA concentration was significantly greater in patients receiving mechanistic target of rapamycin inhibitor-based immunosuppression compared to patients given calcineurin inhibitors. The use of mycophenolic acid did not impact on the response to ribavirin.

Conclusion: An early response to ribavirin can be used to define the optimal duration of therapy in the setting of HEV infection.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiviral Agents / therapeutic use
  • Calcineurin Inhibitors / therapeutic use
  • Child
  • Female
  • Hepatitis E / complications
  • Hepatitis E / drug therapy*
  • Hepatitis E / surgery*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Organ Transplantation / adverse effects*
  • Predictive Value of Tests
  • RNA, Viral / analysis
  • Ribavirin / therapeutic use*
  • Virus Replication / drug effects
  • Young Adult


  • Antiviral Agents
  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • RNA, Viral
  • Ribavirin