Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.553
Peer-review started: February 13, 2019
First decision: April 11, 2019
Revised: June 11, 2019
Accepted: June 17, 2019
Article in press: June 17, 2019
Published online: June 27, 2019
Processing time: 136 Days and 22.7 Hours
Hepatitis E virus (HEV) infection is a cause of chronic hepatitis in immunosuppressed patients. Sustained virologic response rates to a 12-wk course of ribavirin therapy were reported to be > 70% in the West. This study describes the outcome of HEV treatment in a transplant center in Singapore.
To study the outcome of ribavirin treatment in a series of chronic HEV patients, and the cause of treatment failure.
We studied all of the transplant recipients who were diagnosed with HEV infection between 2012 to 2015. The outcome of therapy and virologic relapse are monitored for three years after the end of therapy.
Ten transplant recipients (4 liver, 5 kidney, and 1 bone marrow transplantation) with positive HEV RNA were studied. Nine patients received at least 12 wk of ribavirin therapy, and the remaining patient resolved after reducing immunosuppression therapy. Two subjects had prolonged viremia that lasted more than one year, despite continuous ribavirin therapy. Four ribavirin-treated patients (44.4%) had HEV RNA relapse after achieving a virologic response by the end of treatment. The overall failure rate is 66.7%. Being a kidney transplant recipient is the strongest risk factor for not achieving an initial sustained virologic response (0/5 treated, Chi-Square test, P < 0.05). The most common side effect of ribavirin is anemia (100%) (haemoglobin reduction of 3-6.2 g/dL). Seven patients required either a blood transfusion or erythropoietin therapy.
The sustained virologic response rate of 12-wk ribavirin therapy for HEV infection in this Asian series was lower than expected. Kidney transplant recipients had a higher rate of treatment failure due to higher immunosuppression requirements and adverse effects.
Core tip: Hepatitis E virus (HEV) infection is a cause of chronic hepatitis in immunosuppressed patients. Sustained virologic response (SVR) rate to a 12-wk course of ribavirin therapy was reported to be > 70% in the West. This study describes the outcome of HEV treatment in a transplant centre in Singapore. Ten transplant recipients (liver, kidney, bone marrow transplantation) with positive HEV RNA were studied. The SVR rate of 12-wk ribavirin therapy for HEV infection in this Asian series was lower than expected; an overall failure rate of 66.7%. Kidney transplant recipients had a higher treatment failure due to higher immunosuppression requirements and adverse effects.