Manifestations extra-

hepatiques du VHE

Vincent Mallet, MD, PhD

CHU Cochin, Université Paris

Descartes, APHP, Inserm

Hoofnagle JH et al. N Engl J Med 2012;367:1237-1244.

Structure of the Hepatitis E Virus (HEV) and Its RNA Genome.

n = 10 569 donneurs

IgG anti-VHE : 22,4 %

Séroprévalence anti-VHE

chez les donneurs de sang

Ile de France

0.8

1.0

3.6

1.1

4.6 3.3

2.2

3.2

1.1

1.1

2.1

3.8

1.1

1.2

1.4

1.4

1.5

1.1

1.0

3.9

2.5

0.4

1.8

1.4

0.5

1.0 0.9

1.0

1.3

0.4

0.9

1.1

1.6

1.8

2.1

0.5

2.4

1.1

1.7

1.6

0.9

1.7

2.6

3.5

0.9

2.1

0.9 1.1

0.6

1 à 10 %

10 à 20 %

20 à 30 %

30 à 40 %

40 à 50 %

60 à 70 %

> 80 %

IgM anti-VHE : 1 %

Mansuy, Hepatology 2016

Séroprévalence anti-VHE

chez les donneurs de sang

Debing et al. J Hepatol, 2016;65 (1) 200-12

Hepatitis E transmission

Hoofnagle JH et al. N Engl J Med 2012;367:1237-1244.

Course of Acute HEV Infection.

Kamar N et al. N Engl J Med 2014;370:1111-1120.

Hepatitis E Virus (HEV) Concentration during Ribavirin Therapy.

Extrahepatic manifestations

Pischke et al. J Hepatol, 2017;66 (5)1082–95

Debing et al. J Hepatol, 2016;65 (1) 200-12

Clinical and virological courses under antiviral treatment in a Caucasian male with a

CD30(+) cutaneous T-cell lymphoproliferative disorder and chronic HEV infection

Hepatitis E virus-induced primary cutaneous

CD30(+) T cell lymphoproliferative disorder

Mallet et al. J Hepatol, 2017; 17: 32250-X

Journal of Hepatology DOI: (10.1016/j.jhep.2017.08.011)

Copyright © 2017 European Association for the Study of the Liver Terms and Conditions

A B

C D

E F

TCRβ/CDR3 high-throughput sequencing of circulating

and tissue-resident T cells.

Journal of Hepatology DOI: (10.1016/j.jhep.2017.08.011)

Copyright © 2017 European Association for the Study of the Liver Terms and Conditions

Key messages on HEV

• First cause of acute hepatitis worldwide

• Emerging autochtonous infectious disease

• HEV should always be searched in the setting of

acute/chronic unexplained liver disease

• Use PCR

• Ribavirin is a treatment of HEV

• Extrahepatic replication of HEV accounts for

extrahepatic diseases, including

lymphoproliferative disorders

Recommendations

• Compromised patients should be informed about

the risks of foodborne transmission of HEV (A III)

• For patients with chronic HEV, reduction of

immunosuppressive drugs could be considered

(B III)

• For patients with chronic HEV, antiviral therapy

with ribavirin could be considered (B III) Mallet V, et al. Management of viral hepatitis in patients with haematological malignancy and in patients undergoing haemopoietic stem cell transplantation: recommendations of the 5th European Conference on Infections in Leukaemia (ECIL-5). Lancet Infect Dis. 2016;16(5):606-17.

Acute hepatitis during SCT/chemotherapy:

Screening recommendations

HBV (AII) HBsAg, NAT

HEV (AIII) NAT

HCV (AIII) NAT

Anti-HAV IgM antibodies

(AIII)

Anti-HAV IgM antibodies

ADV, CMV, EBV, HSV, VZV1 NAT NAT: Nucleic Acid Testing

Mallet V, et al. Management of viral hepatitis in patients with haematological malignancy and in patients undergoing haemopoietic stem cell transplantation: recommendations of the 5th European Conference on Infections in Leukaemia (ECIL-5). Lancet Infect Dis. 2016;16(5):606-17.