Peters van Ton A M, Gevers T J G, Drenth J P H
Department of Gastroenterology & Hepatology, Radboud UMC, Nijmegen, The Netherlands.
J Viral Hepat. 2015 Dec;22(12):965-73. doi: 10.1111/jvh.12403. Epub 2015 Mar 11.
Hepatitis E viral infection can lead to a chronic infection in immunocompromised patients, resulting in progressive liver disease and cirrhosis. Isolated cases have shown that treatment with ribavirin or pegylated interferon-α can result in viral eradication. This systematic review evaluated efficacy and safety of both treatments in chronic hepatitis E. A systematic literature search was performed on PubMed, Web of Science and clinicaltrials.gov for articles and abstracts. The keywords '"Hepatitis E" or HEV' AND 'ribavirin or Rebetol or Copegus' OR 'pegylated interferon OR peginterferon' were combined. The primary outcome was sustained viral response (SVR). Secondary endpoints include rapid viral response (RVR), relapse rates and side effects. Twenty-four studies matched our criteria, representing a total of 105 ribavirin-treated and 8 pegylated interferon-treated patients. The majority of patients had a solid organ transplant. Sixty-four per cent of ribavirin-treated patients achieved a SVR at 6 months after treatment cessation compared to 2/8 peginterferon-treated patients. Ribavirin was relatively well tolerated with the main side effect being anaemia, requiring dose reduction in 28% of patients. Peginterferon leads to acute transplant rejection in 2/8 patients. Ribavirin monotherapy appears to be an effective and safe treatment in all immunocompromised patients with chronic hepatitis E. The use of pegylated interferon in transplant patients may lead to transplant rejection and is not recommended. Therefore, ribavirin should be the antiviral treatment of choice in chronic hepatitis E.
戊型肝炎病毒感染可导致免疫功能低下患者发生慢性感染，进而引发进行性肝病和肝硬化。个别病例显示，使用利巴韦林或聚乙二醇化干扰素-α治疗可实现病毒清除。本系统评价评估了这两种治疗方法对慢性戊型肝炎的疗效和安全性。我们在PubMed、科学网和临床试验.gov上进行了系统的文献检索，以查找相关文章和摘要。检索词为“戊型肝炎”或“HEV”与“利巴韦林”或“利巴韦林”或“可派格”，或“聚乙二醇化干扰素”或“聚乙二醇干扰素”的组合。主要结局为持续病毒学应答（SVR）。次要终点包括快速病毒学应答（RVR）、复发率和副作用。24项研究符合我们的标准，共有105例接受利巴韦林治疗的患者和8例接受聚乙二醇化干扰素治疗的患者。大多数患者接受了实体器官移植。与2/8例接受聚乙二醇化干扰素治疗的患者相比，64%接受利巴韦林治疗的患者在停止治疗6个月后实现了SVR。利巴韦林的耐受性相对较好，主要副作用是贫血，28%的患者需要减少剂量。2/8例患者使用聚乙二醇化干扰素后出现急性移植排斥反应。对于所有免疫功能低下的慢性戊型肝炎患者，利巴韦林单药治疗似乎是一种有效且安全的治疗方法。在移植患者中使用聚乙二醇化干扰素可能会导致移植排斥反应，因此不建议使用。因此，利巴韦林应作为慢性戊型肝炎的抗病毒治疗首选药物。
