Hepatitis E medical therapy: Difference between revisions

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==Overview==
==Overview==
[[Immunocompetent]] patients usually do not require any medical therapy. However, patients with pre-existing [[liver disease]], particularly transplanted patients on [[immunosuppressive therapy]], often develop chronic infection and require [[antiviral]] therapy. [[Antiviral]] therapy may include either [[Ribavirin]] monotherapy (first-line), [[Pegylated interferon-α]] monotherapy, or a combination of both.


==Medical Therapy==
==Medical Therapy==
Line 10: Line 11:
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.<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448  }} </ref>  
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.<ref name="pmid22537448">{{cite journal| author=Wedemeyer H, Pischke S, Manns MP| title=Pathogenesis and treatment of hepatitis e virus infection. | journal=Gastroenterology | year= 2012 | volume= 142 | issue= 6 | pages= 1388-1397.e1 | pmid=22537448 | doi=10.1053/j.gastro.2012.02.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22537448  }} </ref>  


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]].<ref name="pmid21281681">{{cite journal| author=Péron JM, Dalton H, Izopet J, Kamar N| title=Acute autochthonous hepatitis E in western patients with underlying chronic liver disease: a role for ribavirin? | journal=J Hepatol | year= 2011 | volume= 54 | issue= 6 | pages= 1323-4; author reply 1324-5 | pmid=21281681 | doi=10.1016/j.jhep.2011.01.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21281681 }} </ref><ref name="pmid21764632">{{cite journal| author=Gerolami R, Borentain P, Raissouni F, Motte A, Solas C, Colson P| title=Treatment of severe acute hepatitis E by ribavirin. | journal=J Clin Virol | year= 2011 | volume= 52 | issue= 1 | pages= 60-2 | pmid=21764632 | doi=10.1016/j.jcv.2011.06.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21764632 }} </ref><ref name="pmid21764632">{{cite journal| author=Gerolami R, Borentain P, Raissouni F, Motte A, Solas C, Colson P| title=Treatment of severe acute hepatitis E by ribavirin. | journal=J Clin Virol | year= 2011 | volume= 52 | issue= 1 | pages= 60-2 | pmid=21764632 | doi=10.1016/j.jcv.2011.06.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21764632  }} </ref>
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]].<ref name="pmid21281681">{{cite journal| author=Péron JM, Dalton H, Izopet J, Kamar N| title=Acute autochthonous hepatitis E in western patients with underlying chronic liver disease: a role for ribavirin? | journal=J Hepatol | year= 2011 | volume= 54 | issue= 6 | pages= 1323-4; author reply 1324-5 | pmid=21281681 | doi=10.1016/j.jhep.2011.01.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21281681  }} </ref><ref name="pmid21764632">{{cite journal| author=Gerolami R, Borentain P, Raissouni F, Motte A, Solas C, Colson P| title=Treatment of severe acute hepatitis E by ribavirin. | journal=J Clin Virol | year= 2011 | volume= 52 | issue= 1 | pages= 60-2 | pmid=21764632 | doi=10.1016/j.jcv.2011.06.004 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21764632  }} </ref>


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.<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>
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.<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>


===Chronic Hepatitis E===
===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:
Chronic [[HEV infection]] often occurs in transplanted patients. In this group of patients, 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, 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>
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


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> This may include pegylated interferon-α monotherapy; ribavirin monotherapy; or a combination of both.<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="pmid20113176">{{cite journal| author=Kamar N, Rostaing L, Abravanel F, Garrouste C, Esposito L, Cardeau-Desangles I et al.| title=Pegylated interferon-alpha for treating chronic hepatitis E virus infection after liver transplantation. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 5 | pages= e30-3 | pmid=20113176 | doi=10.1086/650488 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20113176  }} </ref><ref name="pmid20373458">{{cite journal| author=Haagsma EB, Riezebos-Brilman A, van den Berg AP, Porte RJ, Niesters HG| title=Treatment of chronic hepatitis E in liver transplant recipients with pegylated interferon alpha-2b. | journal=Liver Transpl | year= 2010 | volume= 16 | issue= 4 | pages= 474-7 | pmid=20373458 | doi=10.1002/lt.22014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20373458  }} </ref><ref name="pmid21969351">{{cite journal| author=Dalton HR, Keane FE, Bendall R, Mathew J, Ijaz S| title=Treatment of chronic hepatitis E in a patient with HIV infection. | journal=Ann Intern Med | year= 2011 | volume= 155 | issue= 7 | pages= 479-80 | pmid=21969351 | doi=10.7326/0003-4819-155-7-201110040-00017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21969351  }} </ref>
Assessment of a potential reduction of the [[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]].<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>
 
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> This may include [[pegylated interferon-α]] monotherapy; [[ribavirin]] monotherapy; or a combination of both.<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="pmid20113176">{{cite journal| author=Kamar N, Rostaing L, Abravanel F, Garrouste C, Esposito L, Cardeau-Desangles I et al.| title=Pegylated interferon-alpha for treating chronic hepatitis E virus infection after liver transplantation. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 5 | pages= e30-3 | pmid=20113176 | doi=10.1086/650488 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20113176  }} </ref><ref name="pmid20373458">{{cite journal| author=Haagsma EB, Riezebos-Brilman A, van den Berg AP, Porte RJ, Niesters HG| title=Treatment of chronic hepatitis E in liver transplant recipients with pegylated interferon alpha-2b. | journal=Liver Transpl | year= 2010 | volume= 16 | issue= 4 | pages= 474-7 | pmid=20373458 | doi=10.1002/lt.22014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20373458  }} </ref><ref name="pmid21969351">{{cite journal| author=Dalton HR, Keane FE, Bendall R, Mathew J, Ijaz S| title=Treatment of chronic hepatitis E in a patient with HIV infection. | journal=Ann Intern Med | year= 2011 | volume= 155 | issue= 7 | pages= 479-80 | pmid=21969351 | doi=10.7326/0003-4819-155-7-201110040-00017 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21969351  }} </ref>
 
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 50%;"
|+ '''Antiviral Therapy'''
|-
! style="width: 75px; background: #4479BA; text-align: center;"|{{fontcolor|#FFF|Drug}}
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Characteristics}}
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Ribavirin Monotherapy'''
| style="background: #DCDCDC; padding: 5px;"|
* First treatment option for patients with chronic hepatitis E
* [[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>
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''Pegylated Interferon-α Monotherapy'''
| style="background: #DCDCDC; padding: 5px;"|
* Must be used with caution since it increases the risk of rejection in [[kidney transplant]]ed 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
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WS}}
{{WH}}


[[Category:Hepatitis|E]]
[[Category:Hepatitis|E]]
[[Category:Viruses]]
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[[Category:Gastroenterology]]
[[Category:Infectious Disease Project]]
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
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Latest revision as of 22:07, 29 July 2020

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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

Immunocompetent patients usually do not require any medical therapy. However, patients with pre-existing liver disease, particularly transplanted patients on immunosuppressive therapy, often develop chronic infection and require antiviral therapy. Antiviral therapy may include either Ribavirin monotherapy (first-line), 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]

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. In this group of patients, viral clearance is the ideal therapeutic target. Three treatment options are available:

Due to the lack of evidence regarding the treatment of chronic hepatitis E, this should be individualized for each patient, according to:

Assessment of a potential reduction of the 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]

Antiviral Therapy
Drug Characteristics
Ribavirin Monotherapy
  • First treatment option for patients with chronic hepatitis E
  • 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[7]
Pegylated Interferon-α Monotherapy
  • Must be used with caution since it increases the risk of rejection in kidney transplanted 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

References

  1. ↑ "Hepatitis E" (PDF).
  2. ↑ Fields, Bernard (2013). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781451105636.
  3. ↑ LastName, FirstName (2011). Lippincott's guide to infectious diseases. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health. ISBN 1605479756.
  4. ↑ 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.
  5. ↑ 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. ↑ 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. ↑ 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. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.

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