Sustained Virologic Response Rate of Hepatitis E Virus Infection Treated With Ribavirin may be Lower in Asian Kidney Transplant Recipients

Hepatitis E Virus (HEV) infection has been reported as a cause of elevated transaminases in post-transplant recipients. The aim of the study was to describe the characteristics and outcome of treatment amongst immunosuppressed patients infected with HEV in an organ transplant center in Singapore Retrospective review of medical records of post-transplant patients with HEV viremia was performed. Statistical analysis was performed using Chi-Square test. Ten transplant recipients (4 liver, 1 bone marrow, 5 kidney) with HEV infection were identified. Nine patients received at least 12 weeks of ribavirin therapy. All treated patients achieved normalization of transaminases within 10 weeks. One had persistent viremia despite prolonged courses of Ribavirin (12 months). 4/9 (44.4%) treated patients had relapse of HEV RNA after initial end of treatment virologic response. Overall failure rate of a 12-week course of ribavirin was 55.6% (5/9). Kidney-transplant recipients was the strongest risk factor for not achieving Sustained Virologic Response (SVR). (0 of 5 treated, Chi-Square test, p<0.05). The most common side effect of ribavirin was anemia. All treated patients had decrease in haemoglobin (Hb) levels. (ΔHb = 3-6.2 g/dL). 5/9 patients required dose reductions of Ribavirin. The SVR rate of ribavirin treatment for HEV infection in immunosuppressed hosts may be lower than reported earlier. Kidney transplant recipients are at higher risk of relapse, possibly due to more immunosuppression requirements and lower tolerance for higher ribavirin dosages.