Service d'Hépato-Gastroentérologie, Centre Hospitalo-Universitaire Conception, 147 boulevard Baille, 13385 Marseille Cedex 05, France.
J Clin Virol. 2011 Sep;52(1):60-2. doi: 10.1016/j.jcv.2011.06.004. Epub 2011 Jul 18.
Acute hepatitis E is associated with a higher rate of mortality as compared to hepatitis A or B infections in some series. To date no treatment has been recommended for acute hepatitis E. However, ribavirin has been recently reported to be highly effective to treat solid-organ-transplant recipients chronically infected with hepatitis E virus (HEV).
We report here on the use of ribavirin to treat severe acute HEV infection in a non-immunocompromized patient. This 61-year-old-man presented with acute hepatitis with HEV genotype 3. Seven days after admission, prothrombin index was 38%, bilirubinaemia was 550 μmol/L and alanine aminotransferases level was still increasing, reaching 4565IU/L. No hepatic encephalopathy was noted. Ribavirin (1200 mg/day) was introduced.
Liver biological tests showed rapid improvement concurrently with a decrease in HEV RNA levels in serum samples. Therapy was interrupted after 21 days. At that time, ALT had normalized, bilirubinemia was 138 μmol/L, and HEV RNA was almost undetectable in the serum.
Ribavirin therapy could be an effective treatment of severe acute hepatitis E.
在某些系列中，与甲型或乙型肝炎感染相比，急性戊型肝炎的死亡率更高。迄今为止，尚无针对急性戊型肝炎的推荐治疗方法。然而，最近有报道称利巴韦林对慢性感染戊型肝炎病毒（HEV）的实体器官移植受者非常有效。
我们在此报告了利巴韦林在一名非免疫功能低下患者中治疗严重急性 HEV 感染的应用。这名 61 岁男性因急性肝炎和 HEV 基因型 3 入院。入院后第 7 天，凝血酶原指数为 38%，胆红素为 550μmol/L，丙氨酸氨基转移酶水平仍在升高，达到 4565IU/L。未出现肝性脑病。开始给予利巴韦林（1200mg/天）治疗。
肝生物化学检查显示，随着血清样本中 HEV RNA 水平的降低，肝功能迅速改善。治疗在 21 天后中断。此时，ALT 已恢复正常，胆红素为 138μmol/L，血清中几乎检测不到 HEV RNA。
利巴韦林治疗可能是治疗严重急性戊型肝炎的有效方法。
