Chronic hepatitis E viral infection after liver transplantation: a regression of fibrosis following antiviral therapy.

Background: 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 minimisation 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. Clinical case: 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 normalised after 1 month of treatment but without the clearance of HEV. HEV 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). Conclusion: long term treatment with Ribavirin is safe in liver transplant recipients, and without achieving HEV sustained virological response and may induced a biopsy-proven regression of liver fibrosis in a liver transplant recipient with cirrhosis following chronic HEV infection. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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