Donnelly M C, Scobie L, Crossan C L, Dalton H, Hayes P C, Simpson K J
Department of Hepatology and Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow, UK.
Aliment Pharmacol Ther. 2017 Jul;46(2):126-141. doi: 10.1111/apt.14109. Epub 2017 Apr 27.
Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lead to cirrhosis and organ failure.
To detail current understanding of the molecular biology of HEV, diagnostic and therapeutic strategies and propose future directions for basic science and clinical research.
PubMed was searched for English language articles using the key words "hepatitis E", "viral hepatitis", "autochthonous infection", "antiviral therapy", "liver transplantation", "acute", "chronic", "HEV", "genotype", "transmission" "food-borne", "transfusion". Additional relevant publications were identified from article reference lists.
There has been increasing recognition of autochthonous HEV infection in Western countries, mainly associated with genotype 3. Chronic HEV infection has been recognised since 2008, and in transplant recipients this may lead to cirrhosis and organ failure. Modes of transmission include food-borne transmission, transfusion of blood products and solid organ transplantation. Ribavirin therapy is used to treat patients with chronic HEV infection, but new therapies are required as there have been reports of treatment failure with ribavirin.
Autochthonous HEV infection is a clinical issue with increasing burden. Future work should focus on increasing awareness of HEV infection in the developed world, emphasising the need for clinicians to have a low threshold for HEV testing, particularly in immunosuppressed patients. Patients at potential risk of chronic HEV infection must also be educated and given advice regarding prevention of infection.
戊型肝炎病毒（HEV）是发展中国家急性黄疸型肝炎和急性肝衰竭的主要病因。在过去十年中，发达国家对本地获得性戊型肝炎病毒（HEV）感染的认识日益增加。现在已认识到慢性戊型肝炎病毒感染，在移植受者中，这可能导致肝硬化和器官衰竭。
详细阐述目前对戊型肝炎病毒分子生物学、诊断和治疗策略的理解，并为基础科学和临床研究提出未来方向。
使用关键词“戊型肝炎”、“病毒性肝炎”、“本地感染”、“抗病毒治疗”、“肝移植”、“急性”、“慢性”、“戊型肝炎病毒”、“基因型”、“传播”、“食源性”、“输血”在PubMed上搜索英文文章。从文章参考文献列表中识别其他相关出版物。
西方国家对本地戊型肝炎病毒感染的认识日益增加，主要与3型基因型有关。自2008年以来已认识到慢性戊型肝炎病毒感染，在移植受者中，这可能导致肝硬化和器官衰竭。传播方式包括食源性传播、血液制品输血和实体器官移植。利巴韦林疗法用于治疗慢性戊型肝炎病毒感染患者，但由于有关于利巴韦林治疗失败的报道，需要新的治疗方法。
本地戊型肝炎病毒感染是一个负担日益加重的临床问题。未来的工作应侧重于提高发达国家对戊型肝炎病毒感染的认识，强调临床医生对戊型肝炎病毒检测保持低阈值的必要性，特别是在免疫抑制患者中。还必须对有慢性戊型肝炎病毒感染潜在风险的患者进行教育，并就预防感染提供建议。
