Damiris Konstantinos, Aghaie Meybodi Mohamad, Niazi Mumtaz, Pyrsopoulos Nikolaos
Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States.
Department of Medicine - Gastroenterology and Hepatology, Rutgers - New Jersey Medical School, Newark, NJ 07103, United States.
World J Hepatol. 2022 Mar 27;14(3):482-494. doi: 10.4254/wjh.v14.i3.482.
Hepatitis E virus (HEV) originally identified as a cause of acute icteric hepatitis in developing countries has grown to be a cause of zoonotic viral hepatitis in developed countries such as the United States. While there are eight identified genotypes to date, genotype 1 (HEV1), HEV2, HEV3, HEV4 are the most common to infect humans. HEV1 and HEV2 are most common in developing countries including Latina America, Africa and Asia, and are commonly transmitted through contaminated water supplies leading to regional outbreaks. In contrast HEV3 and HEV4 circulate freely in many mammalian animals and can lead to occasional transmission to humans through fecal contamination or consumption of undercooked meat. The incidence and prevalence of HEV in the United States is undetermined given the absence of FDA approved serological assays and the lack of commercially available testing. In majority of cases, HEV infection is a self-limiting hepatitis requiring only symptomatic treatment. However, this is not the case in immunocompromised individuals, including those that have undergone solid organ or stem cell transplantation. In this subset of patients, chronic infection can be life threatening as hepatic insult can lead to inflammation and fibrosis with subsequent cirrhosis and death. The need for re-transplantation as a result of post-transplant hepatitis is of great concern. In addition, there have been many reported incidents of extrahepatic manifestations, for which the exact mechanisms remain to be elucidated. The cornerstone of treatment in immunocompromised solid organ transplant recipients is reduction of immunosuppressive therapies, while attempting to minimize the risk of organ rejection. Subsequent treatment options include ribavirin, and pegylated interferon alpha in those who have demonstrated ribavirin resistance. Further investigation assessing safety and efficacy of anti-viral therapy is imperative given the rising global health burden. Given this concern, vaccination has been approved in China with other investigations underway throughout the world. In this review we introduce the epidemiology, diagnosis, clinical manifestations, and treatment of HEV, with emphasis on immunocompromised individuals in the United States.
戊型肝炎病毒（HEV）最初被认定为发展中国家急性黄疸型肝炎的病因，如今在美国等发达国家已成为人畜共患病毒性肝炎的病因。虽然迄今已确定有8种基因型，但基因型1（HEV1）、HEV2、HEV3、HEV4是最常见的感染人类的基因型。HEV1和HEV2在包括拉丁美洲、非洲和亚洲在内的发展中国家最为常见，通常通过受污染的水源传播，导致区域性疫情爆发。相比之下，HEV3和HEV4在许多哺乳动物中自由传播，可通过粪便污染或食用未煮熟的肉类偶尔传播给人类。鉴于缺乏美国食品药品监督管理局（FDA）批准的血清学检测方法以及缺乏商业化检测手段，美国戊型肝炎的发病率和患病率尚不确定。在大多数情况下，戊型肝炎病毒感染是一种自限性肝炎，仅需对症治疗。然而，免疫功能低下的个体，包括接受实体器官或干细胞移植的个体并非如此。在这部分患者中，慢性感染可能危及生命，因为肝脏损伤可导致炎症和纤维化，继而发展为肝硬化并导致死亡。移植后肝炎导致的再次移植需求备受关注。此外，有许多关于肝外表现的报道事件，其确切机制仍有待阐明。免疫功能低下的实体器官移植受者的治疗基石是减少免疫抑制疗法，同时尽量降低器官排斥的风险。后续治疗选择包括利巴韦林，以及对显示出利巴韦林耐药的患者使用聚乙二醇化干扰素α。鉴于全球健康负担不断增加，评估抗病毒治疗安全性和有效性的进一步研究势在必行。鉴于这一担忧，中国已批准戊型肝炎疫苗接种，世界各地也在进行其他相关研究。在本综述中，我们介绍了戊型肝炎的流行病学、诊断、临床表现和治疗，重点关注美国免疫功能低下的个体。
