A Decade of Chronic #Hepatitis E #Treatment: #Ribavirin Effectiveness, Safety, and the Association of Torque Teno Virus Load With Treatment Outcomes

 

Highlights

    • Ribavirin achieved 81% SVR in immunocompromised patients with chronic HEV.

    • Adverse events occurred in 56% and led to discontinuation in 17%.

    • Ribavirin dose reduction was associated with failure to achieve SVR.

    • Higher baseline HEV RNA levels were associated with non-SVR.

    • Baseline TTV load showed a nonsignificant trend toward higher levels in non-SVR patients.

Abstract

Background

Hepatitis E virus (HEV) affects immunocompromised individuals. Unlike immunocompetent hosts, who rarely develop chronic infection, up to two-thirds of immunocompromised patients progress to chronicity. Ribavirin is the recommended antiviral therapy, yet predictors of sustained virological response (SVR) remain unclear. Torque Teno Virus (TTV), a marker of immunosuppression, has been proposed as a potential predictor of viral clearance.

Objectives

We evaluated ribavirin treatment outcomes and adverse effects in immunocompromised patients with HEV infection, and assessed whether TTV load predicts SVR.

Study Design

A retrospective cohort study was conducted at the University Medical Center Groningen including solid organ transplant recipients (SOTR) and haematology patients treated with ribavirin for HEV infection between 2010 and 2022. Clinical data and stored serum samples were analysed to determine infection duration and TTV load at treatment initiation and after three months. TTV loads in treated patients were compared with TTV loads of transplant recipients who spontaneously cleared HEV.

Results

Fifty-two patients received ribavirin; 27 had confirmed chronic infection. SVR was achieved in 81% of chronic cases. Adverse events occurred in 56%, leading to dose reduction in 25% and discontinuation in 17%. Non-SVR was associated with ribavirin dose reduction, lower mean daily dose, higher baseline HEV RNA, and lower ALT. Baseline TTV load showed a nonsignificant trend toward higher levels in non-SVR patients. TTV loads did not differ between treated patients and spontaneous clearers.

Conclusions

Ribavirin is effective for chronic HEV, but treatment-limiting toxicity is common. Adequate dosing appears critical for achieving SVR. TTV load did not reliably predict treatment outcome, underscoring the need for further research into immunological and virological predictors of response.

Source: 

Link: https://doi.org/10.1016/j.jcv.2026.106003

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#Zoonotic neglected tropical #diseases at the animal-human interface in the Greater #Mekong Subregion: Two decades of surveillance in #Laos and #Cambodia

 

Abstract

Zoonotic neglected tropical diseases (NTDs) remain a substantial but under-recognised source of human morbidity and economic concern in the Greater Mekong Subregion, particularly in settings characterised by close human–animal interaction. This article represents a narrative synthesis of zoonotic disease research conducted in Laos and Cambodia between 2000 and 2025. The review integrates published literature with findings from long-term surveillance programmes conducted by the authors and collaborating institutions in Laos, with comparative insights from Cambodia, to examine the presence, distribution, diversity, and drivers of zoonotic pathogens at the human–animal interface. Evidence demonstrates the endemic presence of a wide range of parasitic, bacterial, and viral zoonoses, including Taenia solium, Trichinella spp., Streptococcus suis, rickettsial infections, melioidosis, hepatitis E virus, and Japanese encephalitis virus. Some of these pathogens are sustained within smallholder livestock systems, informal slaughter, farming practises, food networks, and wet market environments, where limited diagnostic capacity and fragmented surveillance obscure true disease presence. Surveillance innovations, including abattoir-based sampling, cross-sectoral serological studies, environmental surveillance approaches, and molecular diagnostic tools, have improved pathogen detection but have also highlighted persistent structural and behavioural barriers to control. Socio-cultural practices, occupational exposure, wildlife trade, and economic dependencies reinforce transmission dynamics, indicating that biomedical interventions alone are insufficient. Instead, zoonotic disease persistence reflects the interaction of livestock production systems, environmental conditions, diagnostic limitations, and entrenched human behaviours. This review emphasises the need for integrated One Health approaches that combine strengthened surveillance, improved diagnostics, behavioural interventions, and regional collaboration. Addressing zoonotic NTDs in Laos and Cambodia requires coordinated strategies that account for both biological complexity and socio-economic context to achieve sustainable disease control and improved public health outcomes.

Source: 

Link: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014584

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ONWARD: a #OneHealth, pan - #European multidisciplinary #network advancing #surveillance, #research, clinical management and control of zoonotic #hepeviruses

 

Highlight

• HEV remains the leading cause of acute viral hepatitis in Europe

• Surveillance and diagnostics for HEV are heterogeneous across EU/EEA

• Zoonotic HEV circulates widely in pigs, wildlife and food chains

• Rat HEV expands the zoonotic spectrum and clinical burden in Europe

• ONWARD integrates One Health surveillance, research and capacity building

Abstract

Zoonotic hepeviruses, particularly hepatitis E virus (HEV, species Paslahepevirus balayani) represent a major yet underestimated public health challenge in Europe. Despite being the leading cause of acute viral hepatitis, surveillance, diagnostic practices and prevention strategies remain heterogeneous across EU/EEA countries, limiting comparability and hindering accurate burden estimates. Underdiagnosis is further compounded by extrahepatic manifestations and the growing impact of chronic HEV infection in immunocompromised patients. At the human–animal–environment interface, zoonotic HEV circulates widely in domestic pigs, wildlife and food products, while coordinated surveillance and control measures remain inconsistently implemented. The recent recognition of ratHEV (species Rocahepevirus ratti) as a cause of acute and chronic hepatitis in Europe further expands the spectrum of zoonotic hepevirus infections and underscores the need for integrated One Health approaches. To address these challenges, the One Health Zoonotic Hepevirus Network (ONWARD; COST Action CA24140) was launched in 2025 as a pan-European, multidisciplinary collaboration uniting experts across human, veterinary, food safety and environmental health sectors. ONWARD aims to harmonise diagnostic tools, strengthen clinical research, integrate multisectoral surveillance, promote capacity building and support evidence-based policy development. By fostering coordination with European stakeholders ONWARD provides a structured framework to strengthen preparedness, surveillance and response to zoonotic hepevirus threats across Europe.

Source: 

Link: https://www.sciencedirect.com/science/article/pii/S1386653226000338?dgcid=rss_sd_all

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