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The hepatitis E virus (HEV) is one of the main causative agents of acute viral hepatitis worldwide. Over the past decade, HEV genotypes 3 and 4 have been responsible for chronic infections in immunocompromised patients, especially solid organ transplant recipients. A rapid progression of liver fibrosis and the development of HEV-related cirrhosis have been documented in this specific population. HEV infections have also been associated with extrahepatic manifestations such as neurological disorders and kidney injuries. Despite a reduction in immunosuppressive regimens, approximately two-thirds of HEV-infected immunocompromised patients progress to chronic hepatitis and require antiviral therapy. Within the past years, ribavirin has been successfully used to treat chronic HEV infections. Current international guidelines recommend ribavirin monotherapy for a period of 12 weeks as the anti-HEV treatment of choice. The associated sustained virological response is approximately 80%. Nevertheless, a few cases of ribavirin failure have been documented. Further studies are needed to identify novel antiviral therapies for patients who are refractory to ribavirin.

DOI: 10.1007/978-3-030-01751-4_36-1