Hepatitis E medical therapy: Difference between revisions
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| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Ribavirin Monotherapy''' | | style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Ribavirin Monotherapy''' | ||
| style="background: #DCDCDC; padding: 5px;"| | | style="background: #DCDCDC; padding: 5px;"| | ||
* [[HEV]] is often cleared after a few weeks of [[ribavirin]] monotherapy | * First treatment option for this group of patients | ||
* | * [[HEV]] is often cleared after a few weeks of [[ribavirin]] monotherapy | ||
* Usually prescribed '''600 - 1000 mg/day, during 3 months''', however, it must be adjusted to the patient's [[renal function]], in order to avoid [[hemolytic anemia]] induced by the drug<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> | |||
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| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Pegylated Interferon-α Monotherapy''' | | style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Pegylated Interferon-α Monotherapy''' | ||
| style="background: #DCDCDC; padding: 5px;"| | | style="background: #DCDCDC; padding: 5px;"| | ||
* The duration of treatment may range from 3 to 12 months | * Must be used with caution since it increases the risk of rejection in [[kidney transplant]] patients | ||
* Due to its severe side-effects and potential organ rejection, it is not indicated in heart or kidney-tranplanted patients | * The duration of treatment may range from 3 to 12 months | ||
* Due to its severe side-effects and potential organ rejection, it is not indicated in heart or kidney-tranplanted patients | |||
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Revision as of 02:16, 28 August 2014
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Hepatitis E Microchapters |
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Hepatitis E medical therapy On the Web |
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American Roentgen Ray Society Images of Hepatitis E medical therapy |
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Risk calculators and risk factors for Hepatitis E medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Immunocompetent patients are usually able to clear HEV spontaneously, however, patients with pre-existing liver disease, particularly transplanted patients on immunosuppressive therapy, often develop chronic infection and may need antiviral therapy. Antiviral treatment should be individualized to each patient, according to: stage of liver disease; comorbidities; range of possible reduction of immunosuppression; and antiviral drug side-effects. Before antiviral drug therapy, patients should be evaluated for the possibility of reducing immunosuppressive treatment, since 30 % of cases in whom this approach is possible, are cleared from HEV. Antiviral therapy may include: ribavirin monotherapy, which is usually the first treatment option; pegylated interferon-α monotherapy; or a combination of both.
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
Due to the lack of evidence regarding the treatment of chronic hepatitis E, this should be individualized for each patient, according to:
- Stage of liver disease
- Comorbidities
- Range of possible reduction of immunosuppression
- Antiviral drug side-effects
Assessment of a potential reduction of immunosuppressive therapy, particularly of the T-cell suppression, is the initial approach to treat these patients. 30 % of cases in whom this approach is possible, are cleared from HEV.[8][9]
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] This may include pegylated interferon-α monotherapy; ribavirin monotherapy; or a combination of both.[8][10][11][12]
| Drug | Characteristics |
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| Ribavirin Monotherapy |
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| Pegylated Interferon-α Monotherapy |
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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 7.2 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.
- ↑ 8.0 8.1 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.
- ↑ Kamar N, Rostaing L, Abravanel F, Garrouste C, Esposito L, Cardeau-Desangles I; et al. (2010). "Pegylated interferon-alpha for treating chronic hepatitis E virus infection after liver transplantation". Clin Infect Dis. 50 (5): e30–3. doi:10.1086/650488. PMID 20113176.
- ↑ Haagsma EB, Riezebos-Brilman A, van den Berg AP, Porte RJ, Niesters HG (2010). "Treatment of chronic hepatitis E in liver transplant recipients with pegylated interferon alpha-2b". Liver Transpl. 16 (4): 474–7. doi:10.1002/lt.22014. PMID 20373458.
- ↑ Dalton HR, Keane FE, Bendall R, Mathew J, Ijaz S (2011). "Treatment of chronic hepatitis E in a patient with HIV infection". Ann Intern Med. 155 (7): 479–80. doi:10.7326/0003-4819-155-7-201110040-00017. PMID 21969351.