Mazzola Alessandra, Tran Minh Margherita, Charlotte Frédéric, Hdiji Aisha, Bernard Denis, Wendum Dominique, Calmus Yvon, Conti Filomena
1 APHP, Hôpital Pitié-Salpêtrière, Unité Médicale de Transplantation Hépatique, Hépato-Gastro-Enterologie. Hôpital Pitié-Salpêtrière UPMC Paris VI, Boulevard de l'Hôpital, Paris, France. 2 Medicina Traslazionale, Università Piemonte Orientale Amedeo Avogrado, Italy. 3 APHP, Hôpital Pitié-Salpêtrière, Service d'Anatomie et Cytologie Pathologique, Paris, France. 4 APHP, Hôpital Pitié-Salpêtrière, Service d'Anesthésie-Réanimation, Paris, France. 5 APHP, Hôpital Saint Antoine, Service d'Anatomie et Cytologie Pathologique, Paris, France.
Transplantation. 2017 Sep;101(9):2083-2087. doi: 10.1097/TP.0000000000001766.
Hepatitis E virus (HEV) infection is increasingly being reported in immunocompromised patients and particularly organ transplant recipients. In this context, HEV infection frequently evolves to chronic infection with a rapid progression of fibrosis to cirrhosis. Ribavirin monotherapy and a minimization of immunosuppression represent the treatment of choice, with a good response rate. However, no data are available on whether treatment can achieve a regression of liver fibrosis in chronic HEV patients. A 57-year-old male patient received a liver transplant for alcoholic cirrhosis and, 6 years later, developed biopsy-proven chronic HEV infection. The patient received different antiviral therapy regimens (pegylated interferon alpha 2b and ribavirin different dosages, and long-term treatment with ribavirin monotherapy still ongoing) but without achieving a sustained virological response. Liver function parameters normalized after 1 month of treatment but without the clearance of HEV. Hepatitis E virus RNA levels also remained detectable in the serum and stools throughout ribavirin monotherapy. No serious adverse events were reported. A gradual regression of liver fibrosis was reported (Metavir A0/F1 in 2015 versus A3/F4 in 2008). Long-term treatment with ribavirin is safe in liver transplant recipients, without achieving HEV sustained virological response, and may induce a biopsy-proven regression of liver fibrosis in a liver transplant recipient with cirrhosis after chronic HEV infection.
免疫功能低下患者，尤其是器官移植受者中，戊型肝炎病毒（HEV）感染的报道日益增多。在这种情况下，HEV感染常演变为慢性感染，并迅速发展为肝纤维化直至肝硬化。利巴韦林单药治疗以及尽量减少免疫抑制是首选治疗方法，有效率良好。然而，关于治疗能否使慢性HEV患者的肝纤维化消退，尚无相关数据。一名57岁男性患者因酒精性肝硬化接受肝移植，6年后经活检证实发生慢性HEV感染。该患者接受了不同的抗病毒治疗方案（聚乙二醇化干扰素α-2b和不同剂量的利巴韦林，以及仍在进行的利巴韦林单药长期治疗），但未实现持续病毒学应答。治疗1个月后肝功能参数恢复正常，但HEV未清除。在整个利巴韦林单药治疗期间，血清和粪便中均可检测到戊型肝炎病毒RNA水平。未报告严重不良事件。据报道肝纤维化有逐渐消退的情况（2015年Metavir分级为A0/F1，而2008年为A3/F4）。在肝移植受者中，利巴韦林长期治疗是安全的，虽未实现HEV持续病毒学应答，但可能使一名慢性HEV感染后肝硬化的肝移植受者的肝纤维化经活检证实出现消退。
