Background: Ribavirin is currently recommended for treating chronic hepatitis E virus (HEV) infection. This retrospective European multicenter study aimed to assess the sustained virological response (SVR) in a large cohort of solid organ transplant (SOT) recipients with chronic HEV infection treated with ribavirin monotherapy (N = 255), to identify the predictive factors for SVR, and to evaluate the impact of HEV RNA mutations on virological response.
Methods: Data from 255 SOT recipients with chronic HEV infection from 30 European centers were analyzed. Ribavirin was given at the median dose of 600 (range, 29-1200) mg/day (mean, 8.6 ± 3.6 mg/kg/day) for a median duration of 3 (range, 0.25-18) months.
Results: After a first course of ribavirin, the SVR rate was 81.2%. It increased to 89.8% when some patients were offered a second course of ribavirin. An increased lymphocyte count at the initiation of therapy was a predictive factor for SVR, while poor hematological tolerance of ribavirin requiring its dose reduction (28%) and blood transfusion (15.7%) were associated with more relapse after ribavirin cessation. Pretreatment HEV polymerase mutations and de novo mutations under ribavirin did not have a negative impact on HEV clearance. Anemia was the main adverse event.
Conclusions: This large-scale retrospective study confirms that ribavirin is highly efficient for treating chronic HEV infection in SOT recipients and shows that the predominant HEV RNA polymerase mutations found in this study do not affect the rate of HEV clearance.This large-scale retrospective study that included 255 solid organ transplant recipients confirms that ribavirin is highly efficient for treating chronic hepatitis E virus (HEV) infection and shows that HEV RNA polymerase mutations do not play a role in HEV clearance.
Keywords: anemia; hepatitis E virus; organ transplantation; ribavirin; sustained virological response.
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: email@example.com.
Ribavirin for Chronic Hepatitis E Virus Infection in Transplant RecipientsN Kamar et al. N Engl J Med 370 (12), 1111-20. PMID 24645943.This retrospective, multicenter study showed that ribavirin as monotherapy may be effective in the treatment of chronic HEV infection; a 3-month course seemed to be an ap …
An Early Viral Response Predicts the Virological Response to Ribavirin in Hepatitis E Virus Organ Transplant PatientsN Kamar et al. Transplantation 99 (10), 2124-31. PMID 26214817.An early response to ribavirin can be used to define the optimal duration of therapy in the setting of HEV infection.
Prevalence, Morbidity, and Therapy of Hepatitis E Virus Infection in Pediatric Renal Allograft RecipientsSE Cordts et al. Pediatr Nephrol 33 (7), 1215-1225. PMID 29500631.Given an HEV seroprevalence of 13.3% in pediatric renal transplant recipients and an HEV viremia of 4.4%, HEV infection should be considered in patients with otherwise un …
Dosing Ribavirin in Hepatitis E-infected Solid Organ Transplant RecipientsBCM De Winter et al. Pharmacol Res 130, 308-315. PMID 29499270. - ReviewHepatitis E virus (HEV) is the most common cause of viral hepatitis worldwide. Genotypes 1 and 2 (GT1 and GT2) are mainly present in developing countries, while GT3 and G …
Treatment of Hepatitis E VirusHR Dalton et al. Curr Opin Infect Dis 29 (6), 639-644. PMID 27607911. - ReviewRibavirin is an effective treatment for hepatitis E, but further studies are required to determine which other antiviral agents are of clinical utility in treating HEV in …
Cited by 1 PubMed Central articles
Rituximab-Containing Treatment Regimens May Imply a Long-Term Risk for Difficult-To-Treat Chronic Hepatitis EM Schulz et al. Int J Environ Res Public Health 17 (1). PMID 31947836.Hepatitis E virus (HEV) infection is an emerging disease in industrialized countries which is usually characterized by a self-limited course. However, there is an increas …