Treatment for chronic hepatitis E virus infection: A systematic review and meta-analysis.
hepatitis E virus
immunosuppression
ribavirin
systematic review
Journal
Journal of viral hepatitis
ISSN: 1365-2893
Titre abrégé: J Viral Hepat
Pays: England
ID NLM: 9435672
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
10
09
2020
revised:
09
11
2020
accepted:
23
11
2020
pubmed:
11
12
2020
medline:
1
9
2021
entrez:
10
12
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 33301609
doi: 10.1111/jvh.13456
pmc: PMC7898834
doi:
Substances chimiques
Antiviral Agents
0
Interferon-alpha
0
Recombinant Proteins
0
Polyethylene Glycols
3WJQ0SDW1A
Ribavirin
49717AWG6K
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
454-463Informations de copyright
© 2020 The Authors. Journal of Viral Hepatitis published by John Wiley & Sons Ltd.
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