Therapeutic targets
- Improvement of the symptomatology
- Avoidance of complications
- Virus elimination, i.e. cure
Therapy recommendations
- Acute hepatitis E
- In healthy individuals, no specific therapy is usually required, as spontaneous viral elimination occurs in immunocompetent individuals after a few weeks.
- Therapy with ribavirin in:
- Immunosuppressed individuals
- Pregnant women: in pregnant women who suffer a fulminant course in the context of HEV genotype 1 infection, indication for use only after extremely strict benefit-risk assessment because of described teratogenicity (potential of a substance to harm the embryo or fetus in the womb).
- Chronic liver disease patients
- Fulminant course with acute or acute-on-chronic liver failure (ACLF) → immediate transfer to a hepatology center.
- Chronic hepatitis E
- As a first measure in immunosuppressed reduction of immunosuppression, leading to viral elimination in about 30% of cases).
- Monotherapy with ribavirin > 12 weeks.
- Recurrence: renewed monotherapy with ribavirin > 24 weeks; in the absence of success in liver transplanted patients → pegylated interferon alph > 12 weeksNote: In patients who have undergone kidney, pancreas, heart and lung transplantation, interferon is contraindicated due tothe high risk of acute rejection.
Further notes
- An apparent resistance under ribavirin is not a resistance mutation, but is due to the mutant viral polymerase, which works twice as fast as the normal and thus the replication rate (growth rate) of the virus literally explodes. Riboflavin continues to work, but no longer comes against the excess of new viruses.
