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Management and treatment options
Treatment for acute hepatitis E is usually done according to the symptoms of each patient. It is symptomatic treatment with monitoring to prevent complications and improve the patient’s symptoms and quality of life. According to studies, ribavirin may also be used for 21 days in some cases, with a significant reduction of liver enzymes in immunocompetent patients.
When chronic hepatitis E infection is detected, it is imperative to promote viral clearance. This type of treatment is usually recommended for immunocompromised patients and those who receive immunosuppressive therapy. In these cases, immunosuppressive therapy should be reduced, promoting viral clearance in up to 30% of patients. The rest should receive other therapeutic options, such as mTOR inhibitors or calcineurin inhibitors, which slow down the replication of the virus. Antiviral therapy with ribavirin is also considered, especially in patients who cannot reduce their immunosuppressive treatment. An alternative when ribavirin does not work is pegylated interferon-alpha, which is administered for up to a year until HEV RNA levels are controlled.
