Ribavirin treatment of acute and chronic hepatitis E: a single‐centre experience

Background The role of ribavirin for treatment of severe acute or chronic hepatitis E virus ( HEV ) infection is not well defined. Aims To investigate the applicability and efficacy of ribavirin therapy in acute and chronic HEV infections within a large single‐centre cohort. Materials & Methods Clinical courses of forty‐four German HEV ‐infected individuals were analysed. Results In a prospective case series, we observed spontaneous recovery from acute symptomatic HEV ‐infection in 10/11 immunocompetent individuals. Ribavirin therapy was initiated in one patient with severe acute HEV ‐genotype‐1e infection who rapidly improved liver function and cleared HEV . Of 15 organ transplant recipients with prolonged HEV viraemia, reduction in immunosuppression led to HEV ‐clearance in three patients, while ribavirin therapy was initiated in 11 subjects. A rapid response with undetectable HEV ‐ RNA occurred in nine subjects. One patient died after experiencing a virological breakthrough associated with ribavirin dose reduction because of severe anaemia. Discussion Ribavirin is a safe treatment option for HEV infections. However, the optimal dose of ribavirin for the treatment of chronic hepatitis E remains to be determined as treatment failure may occur.