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Ribavirin May Be Effective against Acute Hepatitis E

Ribavirin, a component of standard therapy for chronic hepatitis C, may also be an effective treatment for severe acute hepatitis E, French researchers reported in the July 14, 2011, Journal of Clinical Virology.alt

Acute hepatitis E can cause serious liver inflammation and may cause death as often as hepatitis A; it is especially likely to be life-threatening for pregnant women, with a mortality rate around 20% during the third trimester.

Like hepatitis A, hepatitis E is transmitted by contaminated food or water. It is self-limiting and usually resolves without treatment, while hepatitis B and C can become chronic.

René Gerolami and colleagues used ribavirin, a nucleoside analog that works against hepatitis C virus (HCV) by an unclear mechanism, to treat a patient with severe acute hepatitis E.

To date, no treatment is considered standard therapy for acute hepatitis E, the authors noted as background. However, ribavirin has been recently reported to be highly effective for treating organ transplant recipients infected with hepatitis E virus (HEV).

The treated patient in this report was a 61-year-old-man who presented with acute HEV genotype 3 infection. By 7 days after hospital admission, his prothrombin index (a measure of blood clotting ability) was 38%, his bilirubin level was high at 550 mcmol/L, and his alanine aminotransferase (ALT) level was 4565 IU/L and still increasing, indicating severe liver inflammation. He had not yet developed hepatic encephalopathy (brain impairment), however.

The man was treated with 1200 mg/day ribavirin, the usual upper end of the weight-based dose range used with pegylated interferon for hepatitis C therapy.

Results

  • The patient's plasma HEV RNA viral load level decreased after starting ribavirin.
  • Concurrently his liver biomarker tests showed rapid improvement.
  • Treatment was interrupted after 21 days, at which time his HEV viral load was almost undetectable.
  • At that time his ALT level had normalized and his bilirubin level had fallen to 138 mcmol/L.

Based on these findings, the study authors concluded, "Ribavirin therapy could be an effective treatment of severe acute hepatitis E."

While most people with hepatitis E will not require treatment, ribavirin could be an option for those with severe cases that could lead to adverse outcomes including death. Ribavirin is contraindicated for pregnant women however, since it has been shown to cause birth defects in animal studies.

Investigator affiliations: Service d'Hépato-Gastroentérologie, Centre Hospitalo-Universitaire Conception, Marseille, France; UMR 911-CRO2, Faculté de Médecine, Université de la Méditerranée, Marseille, France.

8/9/11

Reference

R Gerolami, P Borentain, F Raissouni, et al. Treatment of severe acute hepatitis E by ribavirin. Journal of Clinical Virology (abstract). July 14, 2011.