Brief Communication: Case Reports of Ribavirin Treatment for Chronic Hepatitis E

Background: There is currently no accepted treatment of chronic hepatitis E virus (HEV) infection. Objective: To report 2 patients in whom ribavirin therapy seemed to alter the natural history of chronic HEV infection. Design: Case reports. Setting: Hepatology unit of a tertiary care center in France. Patients: A kidney and pancreas transplant recipient and a patient with idiopathic CD4(+) T lymphocytopenia, both with biopsy-proven chronic HEV infection. Intervention: Patients received oral ribavirin, 12 mg/kg of body weight daily for 12 weeks. Measurements: Liver function tests, detection of HEV RNA (viremia and stool shedding) by reverse transcriptase polymerase chain reaction, and anti-HEV IgM and IgG antibodies. Results: Both patients had normalized liver function test results after 2 weeks of treatment and cleared HEV after 4 weeks of treatment. Hepatitis E virus RNA remained undetectable in the serum and stools throughout follow-up (3 months and 2 months for the first and second patient, respectively). Side effects were considered mild. Limitation: Given the relatively short follow-up, the achievement of HEV eradication could not be claimed. Conclusion: Ribavirin is a potentially effective treatment of HEV infection and should be evaluated in patients with chronic HEV infection.