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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.
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