Zhenduanxue lilun yu shijian (Feb 2024)

Advances in the diagnosis and treatment of chronic hepatitis E

  • LU Jie, XIE Qing

DOI
https://doi.org/10.16150/j.1671-2870.2024.01.003
Journal volume & issue
Vol. 23, no. 01
pp. 16 – 22

Abstract

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According to the World Health Organization, hepatitis E virus (HEV) may cause approximately 20 million new infections annually in the world, and potentially lead to more than 3 million cases of acute hepatitis. Prevalence of viral hepatitis E is high in China, and the number of newly-diagnosed hepatitis E cases has exceeded that of newly-diagnosed hepatitis A cases. The reported incidence rate of hepatitis E increased from 1.77/100 000 in 2010 to 2.02/100 000 in 2019. HEV infections in China are mainly due to foodborne infections. Chronic HEV infection is defined as the detection of HEV RNA in blood or stools for more than 3 months. It often occurs in immunocompromised populations and may lead to rapid progression of liver fibrosis and cirrhosis in patients. In China, HEV genotype 4 is the predominant genotype, so chronic hepatitis E patients in China are also mainly infected with HEV genotype 4. The diagnosis of HEV infection is mainly based on specific HEV antibodies or pathogenic indicators. HEV infection screening should focus on patients with underlying liver diseases, women of childbearing age and the elderly, as well as immunocompromised patients (such as organ transplant patients, patients with blood tumor, HIV-infected individuals), etc. There are still many problems in the diagnosis and treatment of HEV, including the unclear risk factors for rapid progression of liver fibrosis in patients with chronic hepatitis E, and the unclear mechanisms on that elderly men and pregnant women are prone to severe cases of HEV infection.The screening of anti-HEV drugs is mostly based on in vitro cell models, which are still in the pre-clinical stage. In the future, research should focus on the pathogenesis of hepatitis E, promoting intersection, integration, and transformation of basic research and clinical research, which may provide impetus for the better diagnosis and treatment of chronic hepatitis E.

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