Universität zu Köln

Affeldt, Patrick ORCID: 0000-0002-3075-0473, Di Cristanziano, Veronica, Grundmann, Franziska, Wirtz, Maike, Kaiser, Rolf, Benzing, Thomas, Stippel, Dirk ORCID: 0000-0002-1107-0907, Kann, Martin ORCID: 0000-0003-2956-1699 and Kurschat, Christine (2021). Monitoring of hepatitis E virus RNA during treatment for chronic hepatitis E virus infection after renal transplantation. IMMUN. INFLAMM. DIS., 9 (2). S. 513 - 521. HOBOKEN: WILEY. ISSN 2050-4527

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Abstract

Background Recently, chronic hepatitis E virus (HEV) infections gained increasing attention as a possible cause for elevated liver enzymes of unknown origin and liver cirrhosis in solid organ transplant recipients. Reduction of immunosuppressive therapy and/or use of antiviral drug ribavirin have been established as possible treatment strategies. Methods The efficacy of dose reduction of mycophenolic acid (MPA) and ribavirin therapy was retrospectively analyzed in eight renal transplant patients of our outpatient clinic who were diagnosed with HEV infection by detection of specific antibodies (immunoglobulin M and immunoglobulin G) and/or positive RNA in blood and stool. In four patients serial HEV viral loads in blood were measured. Results Only one patient reached HEV clearance after reduction of immunosuppressive therapy (predominantly reduction of MPA daily dose) alone, whereas six patients were treated with ribavirin after reduction of immunosuppressive therapy due to persistent virus replication. Four of six patients reached HEV clearance after 3 months of ribavirin therapy. HEV clearance was observed after 34-42 days. Two patients, both treated with rituximab within the last 12 months before diagnosis of HEV infection, needed prolonged ribavirin therapy due to persistent viral replication. Conclusion Reduction of daily dose of MPA therapy alone in transplant patients with chronic HEV infection may not be sufficient to control viral replication. HEV clearance under ribavirin therapy shows interindividual variability. Therefore, serial viral monitoring may be useful to personalize treatment duration. Rituximab therapy is a risk factor for complicated-to-treat chronic HEV infection.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Affeldt, Patrick UNSPECIFIED orcid.org/0000-0002-3075-0473 UNSPECIFIED Di Cristanziano, Veronica UNSPECIFIED UNSPECIFIED UNSPECIFIED Grundmann, Franziska UNSPECIFIED UNSPECIFIED UNSPECIFIED Wirtz, Maike UNSPECIFIED UNSPECIFIED UNSPECIFIED Kaiser, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Benzing, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Stippel, Dirk UNSPECIFIED orcid.org/0000-0002-1107-0907 UNSPECIFIED Kann, Martin UNSPECIFIED orcid.org/0000-0003-2956-1699 UNSPECIFIED Kurschat, Christine UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-568059
DOI:	10.1002/iid3.411
Journal or Publication Title:	IMMUN. INFLAMM. DIS.
Volume:	9
Number:	2
Page Range:	S. 513 - 521
Date:	2021
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	2050-4527
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Immunology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/56805