{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:48:01Z","timestamp":1792496881000,"version":"4.5.0"},"reference-count":129,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T00:00:00Z","timestamp":1562284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Every year, there are an estimated 20 million hepatitis E virus (HEV) infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E. HEV is largely circulating in the west and is associated with several hepatic and extrahepatic diseases. HEV Genotype 1 and 2 infections are waterborne and causative for epidemics in the tropics, while genotype 3 and 4 infections are zoonotic diseases and are mainly transmitted by ingestion of undercooked pork in industrialized nations. The clinical course of these infections differs: genotype 1 and 2 infection can cause acute illness and can lead to acute liver failure (ALF) or acute on chronic liver failure (ACLF) with a high mortality rate of 20% in pregnant women. In contrast, the majority of HEV GT-3 and -4 infections have a clinically asymptomatic course and only rarely lead to acute on chronic liver failure in elderly or patients with underlying liver disease. Immunosuppressed individuals infected with genotype 3 or 4 may develop chronic hepatitis E, which then can lead to life-threatening cirrhosis. Furthermore, several extra-hepatic manifestations affecting various organs have been associated with ongoing or previous HEV infections but the causal link for many of them still needs to be proven. There is no approved specific therapy for the treatment of acute or chronic HEV GT-3 or -4 infections but off-label use of ribavirin has been demonstrated to be safe and effective in the majority of patients. However, in approximately 15% of chronically HEV infected patients, cure is not possible.<\/jats:p>","DOI":"10.3390\/v11070617","type":"journal-article","created":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T11:44:16Z","timestamp":1562327056000},"page":"617","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":121,"title":["The Clinical Perspective on Hepatitis E"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0682-4476","authenticated-orcid":false,"given":"Thomas","family":"Horvatits","sequence":"first","affiliation":[{"name":"Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany"},{"name":"German Center for Infection Research (DZIF), Hamburg-L\u00fcbeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Schulze zur Wiesch","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany"},{"name":"German Center for Infection Research (DZIF), Hamburg-L\u00fcbeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"L\u00fctgehetmann","sequence":"additional","affiliation":[{"name":"German Center for Infection Research (DZIF), Hamburg-L\u00fcbeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany"},{"name":"Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansgar W.","family":"Lohse","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany"},{"name":"German Center for Infection Research (DZIF), Hamburg-L\u00fcbeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Pischke","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Medical Center Hamburg-Eppendorf, 22527 Hamburg, Germany"},{"name":"German Center for Infection Research (DZIF), Hamburg-L\u00fcbeck-Borstel and Heidelberg Partner sites, 22527 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jcv.2016.06.010","article-title":"Hepatitis e virus: Assessment of the epidemiological situation in humans in europe, 2014\/15","volume":"82","author":"Adlhoch","year":"2016","journal-title":"J. Clin. Virol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.jhep.2016.11.016","article-title":"Hepatitis e virus: Infection beyond the liver?","volume":"66","author":"Pischke","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1056\/NEJMra1204512","article-title":"Hepatitis e","volume":"367","author":"Hoofnagle","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1002\/hep.25505","article-title":"The global burden of hepatitis e virus genotypes 1 and 2 in 2005","volume":"55","author":"Rein","year":"2012","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"947","DOI":"10.4315\/0362-028X.JFP-17-290","article-title":"Evaluation of heating conditions for inactivation of hepatitis e virus genotypes 3 and 4","volume":"81","author":"Imagawa","year":"2018","journal-title":"J. Food Prot."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1053\/j.gastro.2012.02.014","article-title":"Pathogenesis and treatment of hepatitis e virus infection","volume":"142","author":"Wedemeyer","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ijfoodmicro.2017.03.008","article-title":"Occurrence of hepatitis a and e and norovirus gi and gii in ready-to-eat vegetables in italy","volume":"249","author":"Terio","year":"2017","journal-title":"Int. J. Food Microbiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ijfoodmicro.2013.09.003","article-title":"Tracing enteric viruses in the european berry fruit supply chain","volume":"167","author":"Maunula","year":"2013","journal-title":"Int. J. Food Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Oeser, C., Vaughan, A., Said, B., Ijaz, S., Tedder, R., Haywood, B., Warburton, F., Charlett, A., Elson, R., and Morgan, D. (2019). Epidemiology of hepatitis e in england and wales: A 10-year retrospective surveillance study, 2008\u20132017. J. Infect. Dis.","DOI":"10.1093\/infdis\/jiz207"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/MEG.0000000000000518","article-title":"Coastal clustering of hev; Cornwall, UK.","volume":"28","author":"Hunter","year":"2016","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ijid.2018.12.011","article-title":"Molecular characterization of human enteric viruses in food, water samples, and surface swabs in sicily","volume":"80","author":"Purpari","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s12560-018-9337-5","article-title":"First report of the presence of hepatitis e virus in scottish-harvested shellfish purchased at retail level","volume":"10","author":"Crossan","year":"2018","journal-title":"Food Environ. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1111\/jam.13614","article-title":"An overview of 20 years of studies on the prevalence of human enteric viruses in shellfish from galicia, spain","volume":"124","author":"Romalde","year":"2018","journal-title":"J. Appl. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/cid\/ciw309","article-title":"Blood-borne hepatitis e virus transmission: A relevant risk for immunosuppressed patients","volume":"63","author":"Pischke","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"851","DOI":"10.7326\/L15-0502","article-title":"Transmission of hepatitis e virus by plasma exchange: A case report","volume":"164","author":"Mallet","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jhep.2018.04.007","article-title":"Hepatitis e blood donor screening-more than a mere drop in the ocean?","volume":"69","author":"Mullhaupt","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/tme.12536","article-title":"Lack of evidence for human serum albumin as major source of hev infections","volume":"28","author":"Horvatits","year":"2018","journal-title":"Transfus. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jhep.2018.02.031","article-title":"Hev-positive blood donations represent a relevant infection risk for immunosuppressed recipients","volume":"69","author":"Westholter","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1111\/trf.13876","article-title":"Red blood cell transfusion-transmitted acute hepatitis e in an immunocompetent subject in europe: A case report","volume":"57","author":"Sauleda","year":"2017","journal-title":"Transfusion"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1111\/trf.14831","article-title":"Thrombotic thrombocytopenic purpura relapse induced by acute hepatitis e transmitted by cryosupernatant plasma and successfully controlled with ribavirin","volume":"58","author":"Bes","year":"2018","journal-title":"Transfusion"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.3201\/eid2006.140140","article-title":"New hepatitis e virus genotype in camels, the middle east","volume":"20","author":"Woo","year":"2014","journal-title":"Emerg. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1099\/jgv.0.000393","article-title":"Proposed reference sequences for hepatitis e virus subtypes","volume":"97","author":"Smith","year":"2016","journal-title":"J. Gen. Virol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Murphy, E.G., Williams, N.J., Jennings, D., Chantrey, J., Verin, R., Grierson, S., McElhinney, L.M., and Bennett, M. (2019). First detection of hepatitis e virus (orthohepevirus c) in wild brown rats (rattus norvegicus) from great britain. Zoonoses Public Health.","DOI":"10.1111\/zph.12581"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.3201\/eid2412.180937","article-title":"Rat hepatitis e virus as cause of persistent hepatitis after liver transplant","volume":"24","author":"Sridhar","year":"2018","journal-title":"Emerg. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Andonov, A., Robbins, M., Borlang, J., Cao, J., Hattchete, T., Stueck, A., Deschaumbault, Y., Murnaghan, K., Varga, J., and Johnston, B. (2019). Rat hepatitis e virus linked to severe acute hepatitis in an immunocompetent patient. J. Infect. Dis.","DOI":"10.1093\/infdis\/jiz025"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hartl, J., Otto, B., Madden, R.G., Webb, G., Woolson, K.L., Kriston, L., Vettorazzi, E., Lohse, A.W., Dalton, H.R., and Pischke, S. (2016). Hepatitis e seroprevalence in europe: A meta-analysis. Viruses, 8.","DOI":"10.3390\/v8080211"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1111\/liv.13859","article-title":"Hepatitis e seroprevalence in the americas: A systematic review and meta-analysis","volume":"38","author":"Horvatits","year":"2018","journal-title":"Liver Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jhep.2015.11.013","article-title":"Stem cell-derived hepatocytes: A novel model for hepatitis e virus replication","volume":"64","author":"Helsen","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.jhep.2016.01.011","article-title":"Human liver chimeric mice as a new model of chronic hepatitis e virus infection and preclinical drug evaluation","volume":"64","author":"Allweiss","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1136\/gutjnl-2015-311109","article-title":"Study of hepatitis e virus infection of genotype 1 and 3 in mice with humanised liver","volume":"66","author":"Sayed","year":"2017","journal-title":"Gut"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1002\/hep.24738","article-title":"Hepatitis e virus (hev)-specific t-cell responses are associated with control of hev infection","volume":"55","author":"Suneetha","year":"2012","journal-title":"Hepatology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1002\/hep.28819","article-title":"Characterization of the specificity, functionality, and durability of host t-cell responses against the full-length hepatitis e virus","volume":"64","author":"Brown","year":"2016","journal-title":"Hepatology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/TP.0b013e3181c4096c","article-title":"Influence of immunosuppressive therapy on the natural history of genotype 3 hepatitis-e virus infection after organ transplantation","volume":"89","author":"Kamar","year":"2010","journal-title":"Transplantation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1086\/650488","article-title":"Pegylated interferon-alpha for treating chronic hepatitis e virus infection after liver transplantation","volume":"50","author":"Kamar","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","first-page":"474","article-title":"Treatment of chronic hepatitis e in liver transplant recipients with pegylated interferon alpha-2b","volume":"16","author":"Haagsma","year":"2010","journal-title":"Liver Transpl."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1053\/j.gastro.2010.08.002","article-title":"Ribavirin therapy inhibits viral replication on patients with chronic hepatitis e virus infection","volume":"139","author":"Kamar","year":"2010","journal-title":"Gastroenterology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"85","DOI":"10.7326\/0003-4819-153-2-201007200-00257","article-title":"Brief communication: Case reports of ribavirin treatment for chronic hepatitis e","volume":"153","author":"Mallet","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1111\/liv.12114","article-title":"Ribavirin treatment of acute and chronic hepatitis e: A single-centre experience","volume":"33","author":"Pischke","year":"2013","journal-title":"Liver Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1056\/NEJMoa1215246","article-title":"Ribavirin for chronic hepatitis e virus infection in transplant recipients","volume":"370","author":"Kamar","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S0140-6736(10)61030-6","article-title":"Efficacy and safety of a recombinant hepatitis e vaccine in healthy adults: A large-scale, randomised, double-blind placebo-controlled, phase 3 trial","volume":"376","author":"Zhu","year":"2010","journal-title":"Lancet"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2018). Easl clinical practice guidelines on hepatitis e virus infection. J. Hepatol., 68, 1256\u20131271.","DOI":"10.1016\/j.jhep.2018.03.005"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1055\/s-0034-1399236","article-title":"Comparison of autochthonous and imported cases of hepatitis a or hepatitis e","volume":"53","author":"Hartl","year":"2015","journal-title":"Z. Gastroenterol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Sebode, M., Pischke, S., Lutgehetmann, M., Polywka, S., Quaas, A., Lohse, A.W., and Wege, H. (2014). New foe treated with old guns-supportive role of steroids in the treatment of acute severe hepatitis e. BMC Gastroenterol., 14.","DOI":"10.1186\/s12876-014-0191-0"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Pischke, S., Gisa, A., Suneetha, P.V., Wiegand, S.B., Taubert, R., Schlue, J., Wursthorn, K., Bantel, H., Raupach, R., and Bremer, B. (2014). Increased hev seroprevalence in patients with autoimmune hepatitis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0085330"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1053\/j.gastro.2011.07.051","article-title":"Acute hepatitis e infection accounts for some cases of suspected drug-induced liver injury","volume":"141","author":"Davern","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1002\/hep.28649","article-title":"The role of hepatitis e virus infection in adult americans with acute liver failure","volume":"64","author":"Fontana","year":"2016","journal-title":"Hepatology"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.hepres.2005.03.017","article-title":"A case of acute hepatitis with positive autoantibodies who actually had hepatitis e virus infection","volume":"32","author":"Nagasaki","year":"2005","journal-title":"Hepatol. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1111\/j.1365-2893.2007.00858.x","article-title":"Fulminant liver failure from acute autochthonous hepatitis e in france: Description of seven patients with acute hepatitis e and encephalopathy","volume":"14","author":"Peron","year":"2007","journal-title":"J. Viral Hepat."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jceh.2013.08.013","article-title":"Hepatitis e and acute-on-chronic liver failure","volume":"3","author":"Kumar","year":"2013","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1136\/gutjnl-2016-312670","article-title":"Acute-on-chronic liver failure: An update","volume":"66","author":"Hernaez","year":"2017","journal-title":"Gut"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","author":"Moreau","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/apt.13309","article-title":"Hepatitis e virus in patients with decompensated chronic liver disease: A prospective uk\/french study","volume":"42","author":"Madden","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1007\/s10620-017-4461-x","article-title":"Acute liver failure due to hepatitis e virus infection is associated with better survival than other etiologies in indian patients","volume":"62","author":"Shalimar","year":"2017","journal-title":"Dig. Dis. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1097\/MCG.0000000000000823","article-title":"Severity and outcome of acute-on-chronic liver failure is dependent on the etiology of acute hepatic insults: Analysis of 368 patients","volume":"51","author":"Shalimar","year":"2017","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/apt.13484","article-title":"Hepatitis e virus infection and acute-on-chronic liver failure in west africa: A case-control study from the gambia","volume":"43","author":"Shimakawa","year":"2016","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1056\/NEJM199801293380503","article-title":"Fulminant hepatitis associated with hepatitis a virus superinfection in patients with chronic hepatitis c","volume":"338","author":"Vento","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1016\/j.jhep.2012.12.013","article-title":"Hepatitis e virus infection: Multiple faces of an underestimated problem","volume":"58","author":"Pischke","year":"2013","journal-title":"J. Hepatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3440","DOI":"10.1128\/JCM.00939-06","article-title":"Identification of genotype 1 hepatitis e virus in samples from swine in cambodia","volume":"44","author":"Caron","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1017\/S0950268818001097","article-title":"The incubation period of hepatitis e genotype 1: Insights from pooled analyses of travellers","volume":"146","author":"Azman","year":"2018","journal-title":"Epidemiol. Infect."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1128\/CMR.00057-13","article-title":"Hepatitis e virus infection","volume":"27","author":"Kamar","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1016\/S0140-6736(00)02737-9","article-title":"Duration of viraemia and faecal viral excretion in acute hepatitis e","volume":"356","author":"Aggarwal","year":"2000","journal-title":"Lancet"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e138","DOI":"10.1111\/jvh.12027","article-title":"Lack of evidence of hepatitis e virus infection among renal transplant recipients in a disease-endemic area","volume":"20","author":"Naik","year":"2013","journal-title":"J. Viral Hepat."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jcv.2013.05.004","article-title":"Hepatitis e virus infections in hiv-infected patients in ghana and cameroon","volume":"58","author":"Feldt","year":"2013","journal-title":"J. Clin. Virol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/s12664-018-0840-2","article-title":"Absence of chronic hepatitis e virus infection in liver transplant recipients: Report from a hyperendemic region","volume":"37","author":"Agarwala","year":"2018","journal-title":"Indian J. Gastroenterol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"omy059","DOI":"10.1093\/omcr\/omy059","article-title":"Chronic genotype 1 hepatitis e infection from immunosuppression for ileo-colonic crohn\u2019s disease","volume":"2018","author":"Robins","year":"2018","journal-title":"Oxf. Med. Case Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"omy125","DOI":"10.1093\/omcr\/omy125","article-title":"Response to: \u2019Chronic genotype 1 hepatitis e infection from immunosuppression for ileo-colonic crohn\u2019s disease\u2019","volume":"2019","author":"Ankcorn","year":"2019","journal-title":"Oxf. Med. Case Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1111\/j.1478-3231.2008.01840.x","article-title":"Hepatitis e and pregnancy: Understanding the pathogenesis","volume":"28","author":"Navaneethan","year":"2008","journal-title":"Liver Int."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Li, M., Bu, Q., Gong, W., Li, H., Wang, L., Li, S., Sridhar, S., Cy Woo, P., and Wang, L. (2019). Hepatitis e virus infection and its associated adverse feto-maternal outcomes among pregnant women in qinhuangdao, china. J. Matern. Fetal Neonatal Med.","DOI":"10.1080\/14767058.2019.1582630"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/j.1440-1746.2007.04913.x","article-title":"Hepatitis e virus infection and fulminant hepatic failure during pregnancy","volume":"22","author":"Jilani","year":"2007","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1086\/505495","article-title":"Hepatic steatosis is associated with fibrosis, nucleoside analogue use, and hepatitis c virus genotype 3 infection in hiv-seropositive patients","volume":"43","author":"McGovern","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1111\/liv.13942","article-title":"Hev in pregnancy: Understanding the crucial role of steroid hormones","volume":"39","author":"Horvatits","year":"2019","journal-title":"Liver Int."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.jhep.2010.08.037","article-title":"High viral load and deregulation of the progesterone receptor signaling pathway: Association with hepatitis e-related poor pregnancy outcome","volume":"54","author":"Bose","year":"2011","journal-title":"J. Hepatol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/liv.13928","article-title":"Role of oestrogen and its receptors in hev-associated feto-maternal outcomes","volume":"39","author":"Singh","year":"2019","journal-title":"Liver Int."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1099\/vir.0.063602-0","article-title":"Evidence of extrahepatic replication of hepatitis e virus in human placenta","volume":"95","author":"Bose","year":"2014","journal-title":"J. Gen. Virol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/17474124.2019.1568869","article-title":"A guide to the management of hepatitis e infection during pregnancy","volume":"13","author":"Kar","year":"2019","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jcv.2014.06.008","article-title":"First case report of an acute hepatitis e subgenotype 3c infection during pregnancy in germany","volume":"61","author":"Tabatabai","year":"2014","journal-title":"J. Clin. Virol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jcv.2012.01.016","article-title":"First case report of an acute genotype 3 hepatitis e infected pregnant woman living in south-eastern france","volume":"54","author":"Anty","year":"2012","journal-title":"J. Clin. Virol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Riveiro-Barciela, M., Buti, M., Homs, M., Campos-Varela, I., Cantarell, C., Crespo, M., Castells, L., Tabernero, D., Quer, J., and Esteban, R. (2014). Cirrhosis, liver transplantation and hiv infection are risk factors associated with hepatitis e virus infection. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0103028"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1056\/NEJMoa0706992","article-title":"Hepatitis e virus and chronic hepatitis in organ-transplant recipients","volume":"358","author":"Kamar","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1056\/NEJMc0708687","article-title":"Chronic hepatitis e with cirrhosis in a kidney-transplant recipient","volume":"358","author":"Gerolami","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.1111\/j.1600-6143.2012.04200.x","article-title":"Chronic hepatitis e in heart transplant recipients","volume":"12","author":"Pischke","year":"2012","journal-title":"Am. J. Transpl."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/tid.12183","article-title":"Course and treatment of chronic hepatitis e virus infection in lung transplant recipients","volume":"16","author":"Pischke","year":"2014","journal-title":"Transpl. Infect. Dis."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.clinre.2016.01.005","article-title":"Persisting hepatitis e virus infection leading to liver cirrhosis despite recovery of the immune system in an hiv-infected patient","volume":"40","author":"Ingiliz","year":"2016","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"a031872","DOI":"10.1101\/cshperspect.a031872","article-title":"Acute and persistent hepatitis e virus genotype 3 and 4 infection: Clinical features, pathogenesis, and treatment","volume":"9","author":"Kamar","year":"2018","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1053\/j.gastro.2017.12.028","article-title":"Chronic hepatitis e in a renal transplant recipient: The first report of genotype 4 hepatitis e virus caused chronic infection in organ recipient","volume":"154","author":"Wang","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"30","DOI":"10.3201\/eid1701.100527","article-title":"Hepatitis e virus infection without reactivation in solid-organ transplant recipients, france","volume":"17","author":"Kamar","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1111\/ajt.12253","article-title":"How should hepatitis e virus infection be defined in organ-transplant recipients?","volume":"13","author":"Kamar","year":"2013","journal-title":"Am. J. Transpl."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"3011","DOI":"10.1111\/ajt.13428","article-title":"Definition of chronic hepatitis e after liver transplant conforms to convention","volume":"15","author":"Meisner","year":"2015","journal-title":"Am. J. Transpl."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1056\/NEJMc0903778","article-title":"Persistent carriage of hepatitis e virus in patients with hiv infection","volume":"361","author":"Dalton","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1002\/jmv.22177","article-title":"Hepatitis e virus infection in patients infected with the human immunodeficiency virus","volume":"83","author":"Kaba","year":"2011","journal-title":"J. Med. Virol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1002\/hep.28384","article-title":"Acute and chronic hepatitis e virus infection in human immunodeficiency virus-infected U.S. Women","volume":"63","author":"Kuniholm","year":"2016","journal-title":"Hepatology"},{"key":"ref_92","doi-asserted-by":"crossref","unstructured":"Pischke, S., Peron, J.M., von Wulffen, M., von Felden, J., Honer Zu Siederdissen, C., Fournier, S., Lutgehetmann, M., Iking-Konert, C., Bettinger, D., and Par, G. (2019). Chronic hepatitis e in rheumatology and internal medicine patients: A retrospective multicenter european cohort study. Viruses, 11.","DOI":"10.3390\/v11020186"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1016\/j.jhep.2017.08.011","article-title":"Hepatitis e virus-induced primary cutaneous cd30 (+) T cell lymphoproliferative disorder","volume":"67","author":"Mallet","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/S1473-3099(16)00118-3","article-title":"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)","volume":"16","author":"Mallet","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1111\/apt.12986","article-title":"Extra-hepatic manifestations of autochthonous hepatitis e infection","volume":"40","author":"Woolson","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1182\/blood-2013-03-492363","article-title":"Hepatitis e virus: An underestimated opportunistic pathogen in recipients of allogeneic hematopoietic stem cell transplantation","volume":"122","author":"Versluis","year":"2013","journal-title":"Blood"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Von Felden, J., Laurent, A., Pischke, S., Aitken, C., Schlabe, S., Spengler, U., Giordani, M.T., Schnitzler, P., Bettinger, D., and Thimme, R. (2019). The burden of hepatitis e among patients with haematological malignancy: A retrospective european cohort study. J. Hepatol.","DOI":"10.1016\/j.jhep.2019.04.022"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.jhep.2017.07.010","article-title":"Hepatitis e virus infection and acute non-traumatic neurological injury: A prospective multicentre study","volume":"67","author":"Dalton","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1212\/WNL.0000000000004297","article-title":"Clinical phenotype and outcome of hepatitis e virus-associated neuralgic amyotrophy","volume":"89","author":"Dalton","year":"2017","journal-title":"Neurology"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.jhep.2018.01.040","article-title":"Association of hepatitis e virus infection and myasthenia gravis: A pilot study","volume":"68","author":"Wang","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1212\/WNL.0000000000000111","article-title":"Guillain-barre syndrome associated with preceding hepatitis e virus infection","volume":"82","author":"Pas","year":"2014","journal-title":"Neurology"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ebiom.2018.08.053","article-title":"Hepatitis e virus infection in acute non-traumatic neuropathy: A large prospective case-control study in China","volume":"36","author":"Wang","year":"2018","journal-title":"EBioMedicine"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ebiom.2018.09.004","article-title":"Extrahepatic manifestations and hev, the genotype matters","volume":"36","author":"Horvatits","year":"2018","journal-title":"EBioMedicine"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.virusres.2015.12.012","article-title":"Antigen detection and apoptosis in mongolian gerbil\u2019s kidney experimentally intraperitoneally infected by swine hepatitis e virus","volume":"213","author":"Soomro","year":"2016","journal-title":"Virus Res."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jhep.2015.08.034","article-title":"Detection and assessment of infectivity of hepatitis e virus in urine","volume":"64","author":"Geng","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/tid.12353","article-title":"Successful treatment of hepatitis e virus-associated cryoglobulinemic membranoproliferative glomerulonephritis with ribavirin","volume":"17","author":"Josse","year":"2015","journal-title":"Transpl. Infect. Dis."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1136\/gutjnl-2017-314884","article-title":"High prevalence of hepatitis e virus in semen of infertile male and causes testis damage","volume":"67","author":"Huang","year":"2018","journal-title":"Gut"},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Horvatits, T., Varwig-Janssen, D., Schulze Zur Wiesch, J., L\u00fcbke, R., Reucher, S., Frerk, S., Addo, M., Schneider, S.W., Lohse, A.W., and Luetgehethmann, M. (2019). No link between male infertility and hev genotype 3 infection. Gut.","DOI":"10.1136\/gutjnl-2019-319027"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.3851\/IMP2317","article-title":"Ribavirin therapy for hepatitis e virus-induced acute on chronic liver failure: A preliminary report","volume":"17","author":"Goyal","year":"2012","journal-title":"Antivir. Ther."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1007\/s40264-017-0566-6","article-title":"The ribavirin pregnancy registry: An interim analysis of potential teratogenicity at the mid-point of enrollment","volume":"40","author":"Sinclair","year":"2017","journal-title":"Drug Saf."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jcv.2011.06.004","article-title":"Treatment of severe acute hepatitis e by ribavirin","volume":"52","author":"Gerolami","year":"2011","journal-title":"J. Clin. Virol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/j.jhep.2011.01.009","article-title":"Acute autochthonous hepatitis e in western patients with underlying chronic liver disease: A role for ribavirin?","volume":"54","author":"Peron","year":"2011","journal-title":"J. Hepatol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/liv.12911","article-title":"Treatment of autochthonous acute hepatitis e with short-term ribavirin: A multicenter retrospective study","volume":"36","author":"Peron","year":"2016","journal-title":"Liver Int."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1053\/j.gastro.2011.02.050","article-title":"Factors associated with chronic hepatitis in patients with hepatitis e virus infection who have received solid organ transplants","volume":"140","author":"Kamar","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ebiom.2016.07.039","article-title":"Hepatitis e virus mutations: Functional and clinical relevance","volume":"11","author":"Hoan","year":"2016","journal-title":"EBioMedicine"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1053\/j.gastro.2014.08.040","article-title":"A mutation in the hepatitis e virus rna polymerase promotes its replication and associates with ribavirin treatment failure in organ transplant recipients","volume":"147","author":"Debing","year":"2014","journal-title":"Gastroenterology"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1136\/gutjnl-2015-311000","article-title":"In vivo evidence for ribavirin-induced mutagenesis of the hepatitis e virus genome","volume":"65","author":"Todt","year":"2016","journal-title":"Gut"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Todt, D., Walter, S., Brown, R.J., and Steinmann, E. (2016). Mutagenic effects of ribavirin on hepatitis e virus-viral extinction versus selection of fitness-enhancing mutations. Viruses, 8.","DOI":"10.3390\/v8100283"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1053\/j.gastro.2015.09.011","article-title":"Sofosbuvir inhibits hepatitis e virus replication in vitro and results in an additive effect when combined with ribavirin","volume":"150","author":"Debing","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jhep.2016.09.014","article-title":"Sofosbuvir shows antiviral activity in a patient with chronic hepatitis e virus infection","volume":"66","author":"Zaaijer","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"463","DOI":"10.3851\/IMP3227","article-title":"Chronic hepatitis e in a heart transplant patient: Sofosbuvir and ribavirin regimen not fully effective","volume":"23","author":"Todesco","year":"2018","journal-title":"Antivir. Ther."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"e625","DOI":"10.1016\/S0618-8278(19)30228-2","article-title":"Efficacy and safety of sofosbuvir monotherapy in patients with chronic hepatitis e-the hepnet sofe pilot study","volume":"70","author":"Cornberg","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.antiviral.2016.11.011","article-title":"The natural compound silvestrol is a potent inhibitor of ebola virus replication","volume":"137","author":"Biedenkopf","year":"2017","journal-title":"Antivir. Res."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1099\/jgv.0.001089","article-title":"Evaluation of antiviral efficacy of chinese traditional medicine babao dan in rabbits infected with hepatitis e virus","volume":"99","author":"Gong","year":"2018","journal-title":"J. Gen. Virol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"e625","DOI":"10.1016\/S0618-8278(19)31442-2","article-title":"Zinc\/ribavirin: A possible treatment option in chronically hev genotype 3 infected patients without svr under ribavirin monotherapy","volume":"70","author":"Horvatits","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1056\/NEJMoa061847","article-title":"Safety and efficacy of a recombinant hepatitis e vaccine","volume":"356","author":"Shrestha","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1002\/hep.25522","article-title":"Safety of the hepatitis e vaccine for pregnant women: A preliminary analysis","volume":"55","author":"Wu","year":"2012","journal-title":"Hepatology"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0140-6736(95)90761-0","article-title":"Vertical transmission of hepatitis e virus","volume":"345","author":"Khuroo","year":"1995","journal-title":"Lancet"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.ijgo.2003.11.018","article-title":"Hepatitis e in pregnancy","volume":"85","author":"Kumar","year":"2004","journal-title":"Int. J. Gynaecol. Obs."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/11\/7\/617\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:02:57Z","timestamp":1760187777000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/11\/7\/617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,5]]},"references-count":129,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2019,7]]}},"alternative-id":["v11070617"],"URL":"https:\/\/doi.org\/10.3390\/v11070617","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,5]]}}}