Hepatitis E: from acute-on-chronic liver failure to chronic hepatitis E: Indications for ribavirin therapy

Hepatitis E is a worldwide infectious disease of the liver caused by the hepatitis E virus (HEV). Depending on the genotype, HEV infections present with different clinical facets: tropical genotypes 1 and 2 are associated with typically self-limited acute hepatitis and are transmitted via contaminated water. Genotypes 3 and 4, which are prevalent in industrialized countries, are associated primarily with consumption of inadequately cooked pork and can lead to acute, chronic but also clinically inapparent courses of the disease. Beside fulminant hepatitis with acute liver failure, acute hepatitis E in patients with underlying chronic liver disease can lead to acute-on-chronic liver failure. Chronic hepatitis E can lead to the establishment of liver cirrhosis along with clinically relevant complications. In addition, extrahepatic manifestations, especially neurological and immunological syndromes, as well as sites of replication outside the liver are increasingly becoming the focus of attention. In this review article, epidemiological and clinical aspects as well as indications of antiviral therapy in hepatitis E are presented and discussed.