Treatment of severe acute hepatitis E by ribavirin

Background: Acute hepatitis E is associated with a higher rate of mortality as compared to hepatitis A or B infections in some series. To date no treatment has been recommended for acute hepatitis E. However, ribavirin has been recently reported to be highly effective to treat solid-organ-transplant recipients chronically infected with hepatitis E virus (HEV). Objective and study design: We report here on the use of ribavirin to treat severe acute HEV infection in a non-immunocompromized patient. This 61-year-old-man presented with acute hepatitis with HEV genotype 3. Seven days after admission, prothrombin index was 38%, bilirubinaemia was 550 mu mol/L and alanine aminotransferases level was still increasing, reaching 4565 IU/L. No hepatic encephalopathy was noted. Ribavirin (1200 mg/day) was introduced. Results: Liver biological tests showed rapid improvement concurrently with a decrease in HEV RNA levels in serum samples. Therapy was interrupted after 21 days. At that time, ALT had normalized, bilirubinemia was 138 mu mol/L, and HEV RNA was almost undetectable in the serum. Conclusion: Ribavirin therapy could be an effective treatment of severe acute hepatitis E. (C) 2011 Elsevier B.V. All rights reserved.