{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:55:48Z","timestamp":1793087748583,"version":"4.5.0"},"reference-count":207,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T00:00:00Z","timestamp":1579824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis throughout the world. Most infections are acute but they can become chronic in immunocompromised patients, such as solid organ transplant patients, patients with hematologic malignancy undergoing chemotherapy and those with a human immunodeficiency virus (HIV) infection. Extra-hepatic manifestations, especially neurological and renal diseases, have also been described. To date, four main genotypes of HEV (HEV1-4) were described. HEV1 and HEV2 only infect humans, while HEV3 and HEV4 can infect both humans and animals, like pigs, wild boar, deer and rabbits. The real epidemiology of HEV has been underestimated because most infections are asymptomatic. This review focuses on the recent advances in our understanding of the pathophysiology of acute HEV infections, including severe hepatitis in patients with pre-existing liver disease and pregnant women. It also examines the mechanisms leading to chronic infection in immunocompromised patients and extra-hepatic manifestations. Acute infections are usually self-limiting and do not require antiviral treatment. Conversely, a chronic HEV infection can be cleared by decreasing the dose of immunosuppressive drugs or by treating with ribavirin for 3 months. Nevertheless, new drugs are needed for those cases in which ribavirin treatment fails.<\/jats:p>","DOI":"10.3390\/jcm9020331","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T11:01:00Z","timestamp":1579863660000},"page":"331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":134,"title":["Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7908-1576","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Lhomme","sequence":"first","affiliation":[{"name":"Virology Laboratory, National Reference Center for Hepatitis E Virus, Toulouse Purpan University Hospital, 31300 Toulouse, France"},{"name":"INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, 31300 Toulouse, France"},{"name":"Universit\u00e9 Toulouse III Paul Sabatier, 31330 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9702-1833","authenticated-orcid":false,"given":"Olivier","family":"Marion","sequence":"additional","affiliation":[{"name":"INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, 31300 Toulouse, France"},{"name":"Universit\u00e9 Toulouse III Paul Sabatier, 31330 Toulouse, France"},{"name":"Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, 31400 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Abravanel","sequence":"additional","affiliation":[{"name":"Virology Laboratory, National Reference Center for Hepatitis E Virus, Toulouse Purpan University Hospital, 31300 Toulouse, France"},{"name":"INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, 31300 Toulouse, France"},{"name":"Universit\u00e9 Toulouse III Paul Sabatier, 31330 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8462-3234","authenticated-orcid":false,"given":"Jacques","family":"Izopet","sequence":"additional","affiliation":[{"name":"Virology Laboratory, National Reference Center for Hepatitis E Virus, Toulouse Purpan University Hospital, 31300 Toulouse, France"},{"name":"INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, 31300 Toulouse, France"},{"name":"Universit\u00e9 Toulouse III Paul Sabatier, 31330 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1930-8964","authenticated-orcid":false,"given":"Nassim","family":"Kamar","sequence":"additional","affiliation":[{"name":"INSERM UMR1043, Center for Pathophysiology of Toulouse Purpan, 31300 Toulouse, France"},{"name":"Universit\u00e9 Toulouse III Paul Sabatier, 31330 Toulouse, France"},{"name":"Department of Nephrology and Organs Transplantation, Toulouse Rangueil University Hospital, 31400 Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17086","DOI":"10.1038\/nrdp.2017.86","article-title":"Hepatitis E virus infection","volume":"3","author":"Kamar","year":"2017","journal-title":"Nat. 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