HEPATITIS E – EFFECT ON THE LIVER AND BEYOND

Abstract

Introduction. Hepatitis E is an acute liver disease caused by E hepatitis virus (HEV), representing a global public health problem comparable with other transmissible infections. Aim. The purpose of this paper is to present the epidemiological, clinical, biological and evolutive aspects of HEV infection. Material and method. An estimated 20 million infections are annually reported worldwide with higher prevalence rates recorded in South-East Asia (over 60% of infections and over 65% of HEV related deaths). In Romania the incidence of HEV in 2009 was 12%, the frequency of infection being limited to the anti-HEV specific IgG antibodies seroprevalence. Results. HEV transmission is predominantly by digestive tract (especially contaminated water) but also by blood, plasma, organ transplant. The incubation period ranges from 21 to 45 days, onset of gastrointestinal simptoms, fever, influenza-like syndrome, asthenia, skin rush, weight loss, abdominal pain, dehydration. The state period is characterized by sclero-tegumentary jaundice (75% cases), skin pruritus, steathoresis, dark urine and pale stools. HEV can cause extrahepatic manifestations (neurological, renal lesions, pancreatitis and haematological disturbencies). Farmacological treatment of HEV infection includes Peg-Inf, Ribavirin and also newest DAAs agents. Discussions. In most patients hepatitis E causes a self-limited disease that lasts for several weeks. Acute infection is generally asymptomatic and is caused by genotype 1 in young people, while genotypes 3 and 4 generally affect immunosuppressed patients. Chronic infection is caused by genotypes 3 and 4 in immunosuppressed pacients (transplanted, HIV-positive and haematological patients) and has a lower incidence and mortality. Evolution of viral hepatitis E may be severe and fulminant due to acute liver failure. A recombinant vaccine approved in China in 2011 opens up prospects for the specific prevention measures in areas identified as being at risk to limit the consequences of hepatitis E virus infection in the general population and exposed groups. Conclusions. Hepatitis E management involves the therapy of chronic infection in immunosuppressed patients, the extrahepatic manifestations and also acute severe HEV infections.

Keywords

• hepatitis e virus
• genotypes
• immunosuppressed host
• treatment