Abstract:
The hepatitis E virus (HEV) is a RNA virus which is the leading cause of acute viral hepatitis worldwide, with at least 20 million infections annually. Four main genotypes of HEV have been described (HEV1 to 4). HEV1 and HEV2 are the main human pathogens, whereas HEV3 and HEV4 mainly cause zoonotic diseases. HEV can be transmitted mainly via the faecal-oral route and partly via blood transfusion and vertical route. The diagnosis of HEV infection can be based on the presence of anti-hepatitis E antibodies, HEV RNA, or HEV Antigen in blood or stools. HEV infection can result in a range of outcomes, including acute and chronic hepatitis, liver failure and extra-hepatic manifestations such as neurological and renal symptoms. Acute hepatitis E is typically self-limiting and does not necessitate special treatments; however, immunocompromised individuals, such as organ transplant recipients, are at an increased risk of developing chronic hepatitis E which require lower doses of immunosuppressive drugs and/or antiviral therapy. Ribavirin and pegylated interferon-alpha are the most widely used antiviral drugs, while sofosbuvir is an alternative drug for patients who are resistant to ribavirin. Vaccines are important methods to prevent HEV infection. Only HEV239 and recombinant protein (rHEV) vaccine have been shown safe and effective characteristics. The HEV239 vaccine is just produced and licensed for use in China, and late-stage clinical trials of the rHEV vaccine have not yet been conducted, so they were not in use. This review focused on the advances in diagnosis, clinical presentation and treatment of HEV infection.