{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:40:01Z","timestamp":1756366801436,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,1,10]]},"abstract":"<jats:p>We present a 38-year-old white British man who was taking long-term immunosuppressive medication following kidney transplantation. On routine review, he was noted to have an isolated and asymptomatic rise in alanine aminotransferase. After thorough investigation, he was found to have positive IgM and IgG serology to hepatitis E virus\u2014and given the duration of his transaminitis, he was determined to have chronic hepatitis E infection. Treatment options were complicated by the presence of his kidney transplant, by chronic anaemia and by his wish for concomitant fertility treatment. Ribavirin therapy was instituted with a dramatic and immediate drop in serum viral load, although stool viraemia persisted. No clear protocols guide duration of treatment in chronic hepatitis E infection, but protracted faecal virus shedding predicts viral recrudescence, and treatment should continue at least until the stool is clear of virus.<\/jats:p>","DOI":"10.1136\/bcr-2017-223592","type":"journal-article","created":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T03:45:17Z","timestamp":1517456717000},"page":"bcr-2017-223592","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Treating chronic hepatitis E: when is enough enough?"],"prefix":"10.1136","volume":"2018","author":[{"given":"Terry John","family":"Evans","sequence":"first","affiliation":[{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Hilton","sequence":"additional","affiliation":[{"name":"Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Douthwaite","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,2,1]]},"reference":[{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1204512"},{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.2","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e32835c2198"},{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.3","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.21656"},{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu742"},{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215246"},{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.6","doi-asserted-by":"crossref","DOI":"10.3390\/v8080222","article-title":"Treatment of HEV Infection in Patients with a Solid-Organ Transplant and Chronic Hepatitis","volume":"8","author":"Kamar","year":"2016","journal-title":"Viruses"},{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.7","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/MOT.0000000000000432","article-title":"Hepatitis E viral infection in solid organ transplant patients","volume":"22","author":"Fang","year":"2017","journal-title":"Curr Opin Organ Transplant"},{"key":"2025082800140942000_2018.jan31_2.bcr-2017-223592.8","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/TP.0000000000001908","article-title":"Summary of the British Transplantation Society UK Guidelines for Hepatitis E and Solid Organ Transplantation","volume":"102","author":"McPherson","year":"2018","journal-title":"Transplantation"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-223592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:14:20Z","timestamp":1756365260000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-223592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,1]]},"references-count":8,"alternative-id":["10.1136\/bcr-2017-223592"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-223592","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,2,1]]}}}