Treatment of chronic hepatitis E in a patient with HIV infection

• Published in: Annals of internal medicine Vol. 155; no. 7; p. 479
• Main Authors: Dalton, Harry R, Keane, Frances E, Bendall, Richard, Mathew, Joe, Ijaz, Samreen
• Format: Journal Article
• Language: English
• Published: United States 04-10-2011
• Subjects: Antiviral Agents - therapeutic use; Drug Therapy, Combination; Hepatitis E - complications; Hepatitis E - drug therapy; HIV Infections - complications; HIV Infections - immunology; Humans; Immunocompromised Host; Interferon-alpha - therapeutic use; Male; Middle Aged; Ribavirin - therapeutic use
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-155-7-201110040-00017

Hepatitis E virus (HEV) infections in immunosuppressed patients can result in chronic hepatitis that rapidly progresses to cirrhosis (1, 2). When immunosuppressed transplant recipients are treated with pegylated -interferon and ribavirin, HEV clears and liver histology improves (2). However, we are not aware of reports about how this therapy works in patients with HIV infection.
To describe the clinical and laboratory response to antiviral therapy for chronic HEV infection in a patient also infected with HIV.
We studied a 48-year-old bisexual male with HIV- 1 infection who was chronically infected with HEV genotype 3a and had several years of painful sensory neuropathy of uncertain cause in the lower limbs (3). He had malaise, persistently abnormal liver function tests, and active inflammation and cirrhosis on liver biopsy (Figure).Before beginning anti-HEV therapy, the patient had an undetectable HIV viral load and a CD4 cell count between 30 and 150 cells/mL for the previous 2 years while receiving combination antiretroviral therapy (abacavir–lamivudine once daily and lopinavir–ritonavir twice daily).