Inserm U563, centre de physiopathologie de Toulouse-Purpan, 31024 Toulouse, France, Laboratoire de virologie, institut fédératif de biologie de Purpan, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France, Service de néphrologie-hypertension artérielle-dialyse-transplantation, hôpital Rangueil, CHU de Toulouse, 31059 Toulouse, France, Inserm U858, 31059 Toulouse, France, Service de médecine interne, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France, Service d’hépatogastroentérologie, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France
Hepatitis E virus (HEV) is an agent responsible for waterborne acute hepatitis in tropical and subtropical areas. Epidemiological and molecular data indicate zoonotic transmission of HEV in industrialized countries. Genotypes 1 and 2 HEV are found only in humans. By contrast, genotypes 3 and 4 HEV have been characterized both in humans and several animal species (pigs, wild-boars, deers and rodents). Hepatitis E can evolve towards chronicity and rapidly progressive cirrhosis in immunosuppressed patients : organ transplant recipients, patients with hematological diseases and immunodeficiency virus type 1 infected patients with low CD4 cell count. So far, genotype 3 has been the only HEV genotype described in chronic hepatitis E. Host factors and the level of immunosuppression are major factors associated with virus persistence. The reduction of immunosuppressive therapy and treatment with alpha-interferon and/or ribavirin are considered as promising therapeutic options.