van der Eijk Annemiek A, Pas Suzan D, de Man Robert A
Department of Viroscience, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Best Pract Res Clin Gastroenterol. 2017 Apr;31(2):143-150. doi: 10.1016/j.bpg.2017.03.006. Epub 2017 Apr 12.
Immunocompromised patients are at risk of acquiring acute hepatitis E virus infection (HEV), leading to chronicity. Chronic HEV infection is associated with persistent viraemia, raised transaminase activity, histological features associated with chronic hepatitis and evidence of rapid development of cirrhosis. Extrahepatic manifestations have been associated with HEV. Most frequently reported are neurological disorders with predominantly involvement of the peripheral nervous system. In patients using immunosuppressive drugs antibody production is often delayed and HEV RNA detection is superior to serology to detect infection. Therapeutic options for chronic HEV includes tapering immunosuppressive and secondly ribavirin, pegylated interferon alpha (PEG-IFN). Present recommendation is to treat chronic HEV patients for 3 months, asses serum HEV RNA and stool HEV RNA and stop therapy if both are undetectable. Studies are required to determine which other antiviral agents than ribavirin and (PEG-)IFN are of clinical utility in treating HEV in the minority of patients who do not respond to ribavirin.
免疫功能低下的患者有感染戊型肝炎病毒（HEV）并导致慢性感染的风险。慢性戊型肝炎病毒感染与持续性病毒血症、转氨酶活性升高、慢性肝炎的组织学特征以及肝硬化快速发展的证据相关。戊型肝炎病毒还与肝外表现有关。最常报告的是神经系统疾病，主要累及周围神经系统。在使用免疫抑制药物的患者中，抗体产生往往延迟，检测戊型肝炎病毒感染时，戊型肝炎病毒RNA检测优于血清学检测。慢性戊型肝炎的治疗选择包括逐渐减少免疫抑制药物用量，其次是利巴韦林、聚乙二醇化干扰素α（PEG-IFN）。目前的建议是对慢性戊型肝炎患者治疗3个月，检测血清和粪便中的戊型肝炎病毒RNA，如果两者均检测不到，则停止治疗。需要开展研究以确定，除利巴韦林和（聚乙二醇化）干扰素之外，还有哪些抗病毒药物对少数对利巴韦林无反应的患者治疗戊型肝炎具有临床效用。
