Variable outcomes of hepatitis E infections in patients with hemato-oncologic diseases

Item Type:	Article
Title:	Variable outcomes of hepatitis E infections in patients with hemato-oncologic diseases
Creators Name:	Ingwersen, V. and Hofmann, J. and Muche, M. and Le Coutre, P. and Schneider, T. and Leng, C. and Burmeister, T. and Maschmeyer, G. and Keller, U. and Schwartz, S.
Abstract:	Introduction The hepatitis E virus (HEV) represents an important cause of viral hepatitis and could cause chronic infections in immunocompromised patients. However, data about immunocompromised patients other than solid organ transplant recipients are limited. Methods We identified patients from a laboratory database and retrospectively compiled and analyzed clinical as well as laboratory data in detail. Results Overall, 22 severely immunosuppressed patients, excluding solid organ transplant recipients, were identified. Four patients did not experience viral clearance (one without and three despite ribavirin therapy). Three patients acquired the infection after allogeneic hematopoietic stem cell transplantation (alloHSCT) and recovered spontaneously, whereas another patient, infected prior to alloHSCT, developed a chronic infection. Four patients failed to clear HEV, resulting in fatal liver failure in two patients. The CD4+ cell counts increased in all but one patient attaining a sustained virological response (SVR), as compared to patients with clinical failure. Severe immunoglobulin deficiency did not appear to obviate the control of HEV. Six of ten (60%) patients with and nine of twelve (75%) patients without ribavirin therapy achieved a SVR. Conclusions Upfront ribavirin therapy does not appear mandatory in patients without CD4+ lymphopenia, but a prolonged HEV-replication carries the risk of liver failure. Our data suggest that chronic HEV-infections could cause T-cell exhaustion, which might be overruled with ribavirin therapy.
Keywords:	Hepatitis E, CD4 Lymphocyte Count, Cancer, Immunosuppression, Allogeneic Stem Cell, Transplantation
Source:	Oncology Research and Treatment
ISSN:	2296-5270
Publisher:	Karger
Volume:	46
Number:	7-8
Page Range:	296-302
Date:	August 2023
Official Publication:	https://doi.org/10.1159/000531538
PubMed:	View item in PubMed

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