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Hepatitis E virus infection

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hepatitis E virus infection are prepared by our editorial team based on guidelines from the European Association for the Study of the Liver (EASL 2023,2018) and the American College of Gastroenterology (ACG 2016). ...
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Screening and diagnosis

Indications for testing: as per EASL 2018 guidelines, test for HEV infection in all patients with symptoms consistent with acute hepatitis.
A
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Diagnostic investigations

Laboratory testing: as per EASL 2018 guidelines, use a combination of serology and NAT testing to diagnose HEV infection.
A

Diagnostic procedures

Kidney biopsy: as per EASL 2018 guidelines, consider renal biopsy for patients with acute or chronic HEV infection who develop new onset proteinuria.
C

Medical management

Indications for treatment
As per EASL 2018 guidelines:
Consider ribavirin treatment in patients with severe acute hepatitis E or acute-on-chronic liver failure.
C
Consider antiviral treatment for patients with chronic hepatitis E infection infection and associated glomerular disease.
C

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  • Duration of treatment

  • Management of non-response to treatment

Nonpharmacologic interventions

Dietary modifications
As per EASL 2018 guidelines:
Advise immunocompromised patients, as well as those with chronic liver diseases, to avoid consumption of undercooked meat (pork, wild boar and venison) and shellfish.
B
Consider advising that immunocompromised patients consume meat only if it has been thoroughly cooked to temperatures of at least 70 degree C.
C

Specific circumstances

Pregnant patients, indications for testing: as per ACG 2016 guidelines, obtain testing for viral hepatitis, including HEV infection, in pregnant patients presenting with acute hepatitis.
B

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  • Pregnant patients (setting of care)

  • Pregnant patients (delivery and breastfeeding)

  • Immunosuppressed patients