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Arch Hellen Med, 30(3), May-June 2013, 263-271


Hepatitis E: New aspects

G.Τ. Kalpakou, S.P. Dourakis
Second Department of Medicine, National and Kapodistrian University of Athens,
Medical School,"Hippokration" General Hospital, Athens, Greece

Hepatitis E until recently was considered to be an epidemic disease, rare in the developed world and always imported from an endemic area. New data show that hepatitis E takes two distinct epidemiological forms, the epidemic form, which is responsible for large outbreaks in the developing world, and a form of locally acquired "autochthonous" disease that occurs in the developed world. This disease has a clinical spectrum ranging from a completely asymptomatic infection to fulminant hepatitis, and it can also be a cause of chronic hepatitis and cirrhosis in immunocompromised patients. Hepatitis E virus (HEV) infection in the developed world is a zoonotic disease and in humans is associated with consumption of swine products and game. It is almost always caused by HEV genotype 3. Overt autochthonous HEV infection usually affects elderly men and has a poor prognosis in patients with previous hepatic problems in whom it results in "acute on chronic" liver failure. Various extrahepatic manifestations of HEV infection, including neurological disorders, have been described. The prevalence of HEV infection is probably underestimated due to the lack of reliable and approved diagnostic assays. Although there are no official guidelines for hepatitis E treatment yet, chronic or severe HEV infection has been treated effectively with ribavirin and or interferon. A vaccination against HEV is a realistic prospect, which would be of use for both epidemiological forms of HEV infection. As research in the field of HEV infection progresses more light is expected to be shed on this newly recognized but old disease.

Key words: Acute hepatitis, Chronic hepatitis, Cirrhosis, Hepatitis E, Hepatitis E virus, Immunocompromised patients.

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