Hepatitis E: A neglected disease

A group of top hepatitis E experts joined me and all together wrote a primer on hepatitis E that is now published in Nature Reviews Disease Primers.

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The Primer in Nature Reviews Disease Primers is here: http://go.nature.com/2iZ33rX

The first question that you can ask is why a nephrologist is leading a group of experts in Hepatology and in Virology and is writing a review paper on hepatitis E? 

In Toulouse University Hospital (Southwest France), all organ-transplant patients are followed in the Department of Nephrology and Organ Transplantation that includes a unit dedicated to all organ-transplant-patients. After my fellowship in Nephrology, in order to obtain a PhD degree, I spent two years in the Department of Virology directed by Pr I.Izopet working on hepatitis C virus infection in kidney-transplant-patients.

In the lab, I heard for the first time talking about a virus called hepatitis E virus (HEV) that seemed to be quite prevalent in our region. HEV was a well known virus that is responsible for self-limiting disease in developing countries and infections observed in developed countries were considered to be only travel-associated. I thought that if this virus is prevalent among the general population in our area, it should be also prevalent among our organ-transplant population.

Hence, I started screening transplant-patients for HEV and found that this virus infected some of them. Thanks to the improvement of serological and molecular tests and the collaboration between virologists and clinicians, our group and others showed that HEV infection is autochthonous in developed countries.

Thereafter, we reported that HEV infection could lead to chronic hepatitis and cirrhosis in immunosuppressed patients. It has also been observed that HEV could be responsible for extra-hepatic manifestations such as neurological and kidney injuries.

Finally, our groups and others tried to treat chronically infected patients with ribavirin, and we reported that ribavirin was very efficient for treating HEV infection. Hence, I have been “infected” by HEV and became interested by this quite unknown virus that its prevalence is underestimated. This allowed me meeting worldwide experts in Hepatology and Virology. Some of these top experts wrote a large part of this primer.

In this primer, we tried to give a complete overview of current knowledge on HEV. In addition to summarizing its virological aspects, mode of transmission, and reservoirs, we described its epidemiology, clinical manifestations, and treatment in developed and in developing world. We also focused on unmet needs for a better understanding of its epidemiology, as well as for its treatment and prevention.

We have worked hard to make the paper complete and comprehensive. Hopefully, you will enjoy reading it and suggest it to your colleagues.

Nassim Kamar

Professor, Toulouse University Hospital