High proportion of complicated treatment courses in patients with chronic hepatitis E infection: Men and older patients may have higher risk for viral relapse, real life data from single centre

Background and aims: Hepatitis E is an RNA-virus infection affecting millions globally. In Europe, zoonotic genotype 3 is predominant. Chronic Hepatitis E occur in immunocompromised patients, requiring reduction of immunosuppression and/or ribavirin treatment. This study analysed all chronic hepatitis E cases (viremia over 12 weeks) from 2016 to 2024 at the University Hospital Duesseldorf to characterize the cohort, describe the different disease courses, and identify relapse-associated characteristics.

Methods: A retrospective analysis was conducted following ethics committee approval. Statistical analysis was performed using Prism Graph Pad.

Results: A total of 41 patients with chronic HEV infection were identified (10 female, median age 54, BMI 24.2, ALT 118 U/l, HEV-RNA 546,055 IU/ml). Among them 21 had prior solid organ transplantation, 13 had stem cell transplantation, and seven had other forms of immunosuppression. Four patients died before HEV treatment, while 30 were treated with ribavirin. Only two organ transplant recipients did not require ribavirin compared to four non-transplant patients. Fourteen patients (46%) treated with ribavirin experienced recurrent HEV-viremia and required prolonged treatment. Male sex and age>50 years is associated with recurrent viremia (p=0.034, p=0.04). Ribavirin dosage, GFR, ALT and HEV-viral load showed no association with HEV relapse (p=0.9, p=0.4, p=0.59, p=0.51). Eight patients had undetectable HEV-IgG. Three cases of viral mutations were identified, with two patients experienced persistent HEV infection despite multiple treatment courses.

Conclusion: Chronic HEV-infection remains a clinical challenge, especially for organ or stem cell transplant patients. Relapse and prolonged treatment is common, highlighting the need for new treatment approaches.

Publication History

Article published online:
20 January 2025