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Meta-Analysis
. 2021 Mar;28(3):454-463.
doi: 10.1111/jvh.13456. Epub 2020 Dec 20.

Treatment for chronic hepatitis E virus infection: A systematic review and meta-analysis

Myrte Gorris  1 , Bernice M van der Lecq  1 , Karel J van Erpecum  1 , Joep de Bruijne  1
Affiliations
Meta-Analysis

Treatment for chronic hepatitis E virus infection: A systematic review and meta-analysis

Myrte Gorris et al. J Viral Hepat. 2021 Mar.

Abstract

Hepatitis E virus infection can cause chronic hepatitis in immunocompromised patients with significant chance of progressive fibrosis and possibly cirrhosis. The aim of this systematic review was to summarize the efficacy and safety of the various treatment options for chronic hepatitis E. We performed a systematic literature search. The primary outcome measure was a sustained virological response (SVR). Secondary end points were rapid virological response (RVR), relapse rates, side effects and adverse events. Forty-four articles were included with a total of 582 patients. Reduction of immunosuppressive medication induced viral clearance in 55/174 (32%) of the patients. Meta-analysis of 395 patients showed a pooled SVR rate of 78% (95-CI 72%-84%) after ribavirin treatment. Twenty-five per cent of the patients obtained a RVR, whereas a relapse occurred in 18% of the patients. Anaemia during treatment led to dose reduction, use of erythropoietin and/or blood transfusion in 37% of the patients. A second treatment attempt with ribavirin led to a SVR in 39/51 (76%) of the patients. Pegylated interferon-alpha was administered to 13 patients and SVR was obtained in 85%. Two patients (15%) suffered from acute transplant rejection during treatment with interferon. In conclusion, reduction of immunosuppressive medication and treatment with ribavirin is safe, generally well tolerated and induced viral clearance in 32% and 78% of patients, respectively. Therefore, ribavirin should be considered as first treatment step for chronic hepatitis E. Treatment with pegylated interferon-alpha increases the risk of transplant rejection and should therefore be administered with great caution.

Keywords: hepatitis E virus; immunosuppression; ribavirin; systematic review.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Literature search and screening process
FIGURE 2
FIGURE 2
SVR rate in 34 studies that report the outcome of ribavirin treatment in patients with chronic hepatitis E. 95% CI, 95%‐confidence interval; Ev/Trt, event/treatment; HEV, hepatitis E virus; SVR, sustained virological response
See this image and copyright information in PMC

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