Hepatitis E medical therapy: Difference between revisions
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===Chronic Hepatitis E=== | ===Chronic Hepatitis E=== | ||
Chronic HEV infection often occurs in transplanted patients. | Chronic [[HEV infection]] often occurs in transplanted patients. Also in this group, viral clearance is the ideal [[therapeutic]] target. Three treatment options are available: | ||
* Reduction of [[immunosupression]] | * Reduction of [[immunosupression]] | ||
* [[Pegylated interferon-α]] | * [[Pegylated interferon-α]] | ||
* [[Ribavirin]] | * [[Ribavirin]] | ||
The initial approach to these patients is the assessment of a potential reduction in immunosuppressive therapy. | The initial approach to these patients is the assessment of a potential reduction in [[immunosuppressive]] therapy, particularly of the [[T-cell]] suppression. 30 % of patients in whom this approach is possible, are cleared from [[HEV]].<ref name="pmid20708006">{{cite journal| author=Kamar N, Rostaing L, Abravanel F, Garrouste C, Lhomme S, Esposito L et al.| title=Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection. | journal=Gastroenterology | year= 2010 | volume= 139 | issue= 5 | pages= 1612-8 | pmid=20708006 | doi=10.1053/j.gastro.2010.08.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20708006 }} </ref><ref name="pmid20145528">{{cite journal| author=Kamar N, Abravanel F, Selves J, Garrouste C, Esposito L, Lavayssière L et al.| title=Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation. | journal=Transplantation | year= 2010 | volume= 89 | issue= 3 | pages= 353-60 | pmid=20145528 | doi=10.1097/TP.0b013e3181c4096c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20145528 }} </ref> | ||
For those patients for whom a reduction of immunosuppression is not possible, and for those who fail to respond to this reduction, antiviral therapy should be considered.<ref name="pmid22549046">{{cite journal| author=Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J et al.| title=Hepatitis E. | journal=Lancet | year= 2012 | volume= 379 | issue= 9835 | pages= 2477-88 | pmid=22549046 | doi=10.1016/S0140-6736(11)61849-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22549046 }} </ref> | |||
==References== | ==References== | ||
Revision as of 15:08, 25 August 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Medical Therapy
As no specific therapy is capable of altering the course of acute hepatitis E infection, prevention is the most effective approach against the disease. Hospitalization is required for fulminant hepatitis and should be considered for infected pregnant women.[1][2][3]
Acute Hepatitis E
The majority of hepatitis E cases in immunocompetent patients are self-limited. Some patients may require symptomatic treatment, however, HEV infection resolves spontaneously in most cases.[4]
Patients with pre-existing liver conditions, may require treatment with ribavirin. A patient who received treatment with ribavirin showed a normalization of bilirubin levels and a decrease in transaminases.[5][6][6]
For developing counties, pregnant women with hepatitis E should be treated, however, a specific treatment regimen has not been established. Ribavirin might be indicated for the treatment of these patients. Despite the teratogenic contra-indications of ribavirin, the risks of HEV infection for the mother and fetus may outweigh the teratogenicity risks of the drug.[7]
Chronic Hepatitis E
Chronic HEV infection often occurs in transplanted patients. Also in this group, viral clearance is the ideal therapeutic target. Three treatment options are available:
- Reduction of immunosupression
- Pegylated interferon-α
- Ribavirin
The initial approach to these patients is the assessment of a potential reduction in immunosuppressive therapy, particularly of the T-cell suppression. 30 % of patients in whom this approach is possible, are cleared from HEV.[8][9]
For those patients for whom a reduction of immunosuppression is not possible, and for those who fail to respond to this reduction, antiviral therapy should be considered.[7]
References
- ↑ "Hepatitis E" (PDF).
- ↑ Fields, Bernard (2013). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781451105636.
- ↑ LastName, FirstName (2011). Lippincott's guide to infectious diseases. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. ISBN 1605479756.
- ↑ Wedemeyer H, Pischke S, Manns MP (2012). "Pathogenesis and treatment of hepatitis e virus infection". Gastroenterology. 142 (6): 1388–1397.e1. doi:10.1053/j.gastro.2012.02.014. PMID 22537448.
- ↑ Péron JM, Dalton H, Izopet J, Kamar N (2011). "Acute autochthonous hepatitis E in western patients with underlying chronic liver disease: a role for ribavirin?". J Hepatol. 54 (6): 1323–4, author reply 1324-5. doi:10.1016/j.jhep.2011.01.009. PMID 21281681.
- ↑ 6.0 6.1 Gerolami R, Borentain P, Raissouni F, Motte A, Solas C, Colson P (2011). "Treatment of severe acute hepatitis E by ribavirin". J Clin Virol. 52 (1): 60–2. doi:10.1016/j.jcv.2011.06.004. PMID 21764632.
- ↑ 7.0 7.1 Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J; et al. (2012). "Hepatitis E." Lancet. 379 (9835): 2477–88. doi:10.1016/S0140-6736(11)61849-7. PMID 22549046.
- ↑ Kamar N, Rostaing L, Abravanel F, Garrouste C, Lhomme S, Esposito L; et al. (2010). "Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection". Gastroenterology. 139 (5): 1612–8. doi:10.1053/j.gastro.2010.08.002. PMID 20708006.
- ↑ Kamar N, Abravanel F, Selves J, Garrouste C, Esposito L, Lavayssière L; et al. (2010). "Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-E virus infection after organ transplantation". Transplantation. 89 (3): 353–60. doi:10.1097/TP.0b013e3181c4096c. PMID 20145528.