Similarities, differences, and possible interactions between hepatitis E and hepatitis C viruses: Relevance for research and clinical practice

Abstract

Hepatitis E virus (HEV) and hepatitis C virus (HCV) are both RNA viruses with a tropism for liver parenchyma but are also capable of extrahepatic manifestations. Hepatitis E is usually a viral acute fecal-oral transmitted and self-limiting disease presenting with malaise, jaundice, nausea and vomiting. Rarely, HEV causes a chronic infection in immunocompromised persons and severe fulminant hepatitis in pregnant women. Parenteral HCV infection is typically asymptomatic for decades until chronic complications, such as cirrhosis and cancer, occur. Despite being two very different viruses in terms of phylogenetic and clinical presentations, HEV and HCV show many similarities regarding possible transmission through organ transplantation and blood transfusion, pathogenesis (production of antinuclear antibodies and cryoglobulins) and response to treatment with some direct-acting antiviral drugs. Although both HEV and HCV are well studied individually, there is a lack of knowledge about coinfection and its consequences. The aim of this review is to analyze current literature by evaluating original articles and case reports and to hypothesize some interactions that can be useful for research and clinical practice.

Keywords: Hepatitis C virus; Hepatitis E virus; Co-infection; Genomic variability; Extra-hepatic diseases; Vaccine

Core Tip: Hepatitis E virus (HEV) and Hepatitis C virus (HCV) are both RNA viruses characterized by greater variability than DNA viruses and mainly infect the liver. Despite these similarities, the two viruses have different species barriers and disease progression. Coinfection with particular HCV and HEV types could aggravate hepatic and/or extrahepatic diseases, taking into account virus–host interactions between the two viruses during viral replication.