Hepatitis E: state of the art

INVITED SPEAKER PRESENTATION Open Access Hepatitis E: state of the art Harry Dalton From 16 th International Symposium on HIV and Emerging Infectious Diseases Marseille, France. 24-26 March 2010 Hepatitis E (HEV) has traditionally been thought to be a disease of developing countries. In this setting, HEV causes hepatitis in young adults. It is generally a self- limiting illness, with a good prognosis, except in preg- nant women and patients with pre-existing chronic liver disease, in whom the mortality is 20% and 70% respectively. Traditionally HEV was considered rare in developed countries, and confined to travellers returning from endemic areas. However, recent data has shown that locally acquired HEV infection is common in developed countries. Acute HEV infection in this setting is caused by HEV genotype 3 and appears to have a predilection for middle aged/elderly males. It has a significant mor- bidity (15%) and carries an adverse prognosis in chronic liver disease. HEV infection is commonly misdiagnosed as drug-induced liver injury. The source and route of infection are currently uncertain, but evidence suggests that HEV genotype 3 is a porcine zoonosis, which can be transmitted via the human food chain. Until very recently chronic HEV infection was thought not to occur. However studies from Europe have shown that HEV genotype 3 can cause chronic infection with rapidly progressive cirrhosis in patients with immuno- compromise. This includes patients taking immunosup- pressive therapy following solid organ transplantation and patients with HIV-1 infection (NEJM 2009; 361(10): 1025-7). HEV IgG seroprevalence in developed countries is variable, with rates of 16% reported from the UK and SW France. These data indicate that HEV infection is either commonly subclinical, or commonly overlooked as a diagnostic possibility. However, the burden of HEV disease in both the developing and developed world is currently uncertain. The worldwide burden of chronic HEV infection may prove to be more considerable than previously thought likely, as countries where HEV is endemic also have a high seroprevalence of HIV. Published: 11 May 2010 doi:10.1186/1742-4690-7-S1-I1 Cite this article as: Dalton: Hepatitis E: state of the art. Retrovirology 2010 7(Suppl 1):I1. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Consultant Gastroenterologist and Hon Senior Lecturer, Royal Cornwall Hospital & Peninsula College of Medicine and Dentistry, Truro, UK Dalton Retrovirology 2010, 7(Suppl 1):I1 http://www.retrovirology.com/content/7/S1/I1 © 2010 Dalton; licensee BioMed Central Ltd.

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Transcript of Hepatitis E: state of the art

INVITED SPEAKER PRESENTATION Open Access

Hepatitis E: state of the artHarry Dalton

From 16th International Symposium on HIV and Emerging Infectious DiseasesMarseille, France. 24-26 March 2010

Hepatitis E (HEV) has traditionally been thought to be adisease of developing countries. In this setting, HEVcauses hepatitis in young adults. It is generally a self-limiting illness, with a good prognosis, except in preg-nant women and patients with pre-existing chronic liverdisease, in whom the mortality is 20% and 70%respectively.Traditionally HEV was considered rare in developed

countries, and confined to travellers returning fromendemic areas. However, recent data has shown thatlocally acquired HEV infection is common in developedcountries. Acute HEV infection in this setting is causedby HEV genotype 3 and appears to have a predilectionfor middle aged/elderly males. It has a significant mor-bidity (15%) and carries an adverse prognosis in chronicliver disease. HEV infection is commonly misdiagnosedas drug-induced liver injury. The source and route ofinfection are currently uncertain, but evidence suggeststhat HEV genotype 3 is a porcine zoonosis, which canbe transmitted via the human food chain.Until very recently chronic HEV infection was thought

not to occur. However studies from Europe have shownthat HEV genotype 3 can cause chronic infection withrapidly progressive cirrhosis in patients with immuno-compromise. This includes patients taking immunosup-pressive therapy following solid organ transplantationand patients with HIV-1 infection (NEJM 2009; 361(10):1025-7).HEV IgG seroprevalence in developed countries is

variable, with rates of 16% reported from the UK andSW France. These data indicate that HEV infection iseither commonly subclinical, or commonly overlookedas a diagnostic possibility. However, the burden of HEVdisease in both the developing and developed world iscurrently uncertain. The worldwide burden of chronicHEV infection may prove to be more considerable than

previously thought likely, as countries where HEV isendemic also have a high seroprevalence of HIV.

Published: 11 May 2010

doi:10.1186/1742-4690-7-S1-I1Cite this article as: Dalton: Hepatitis E: state of the art. Retrovirology 20107(Suppl 1):I1.

Submit your next manuscript to BioMed Centraland take full advantage of:

• Convenient online submission

• Thorough peer review

• No space constraints or color figure charges

• Immediate publication on acceptance

• Inclusion in PubMed, CAS, Scopus and Google Scholar

• Research which is freely available for redistribution

Submit your manuscript at www.biomedcentral.com/submit

Consultant Gastroenterologist and Hon Senior Lecturer, Royal CornwallHospital & Peninsula College of Medicine and Dentistry, Truro, UK