IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v17y2020i1p341-d304956.html
   My bibliography  Save this article

Rituximab-Containing Treatment Regimens May Imply a Long-Term Risk for Difficult-To-Treat Chronic Hepatitis E

Author

Listed:
  • Marten Schulz

    (Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, CVK, 13353 Berlin, Germany
    These authors contributed equally.)

  • Paula Biedermann

    (Division of Viral Gastroenteritis, Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
    These authors contributed equally.)

  • Claus-Thomas Bock

    (Division of Viral Gastroenteritis, Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany)

  • Jörg Hofmann

    (Institute of Virology, Charité Universitätsmedizin Berlin, Labor Berlin—Charité-Vivantes GmbH, 13353 Berlin, Germany)

  • Mira Choi

    (Department of Nephrology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany)

  • Frank Tacke

    (Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, CVK, 13353 Berlin, Germany)

  • Leif Gunnar Hanitsch

    (Institute of Medical Immunology, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
    These authors contributed equally.)

  • Tobias Mueller

    (Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, CVK, 13353 Berlin, Germany
    These authors contributed equally.)

Abstract

Hepatitis E virus (HEV) infection is an emerging disease in industrialized countries which is usually characterized by a self-limited course. However, there is an increased risk of HEV persistence in immunocompromised risk populations, comprising patients following solid organ transplantation or hematological malignancies. Recently, chronic HEV infection following rituximab-containing treatment regimens has been described. Here we report five patients with chronic hepatitis E after prior rituximab therapy for various indications. We determined the immunological characteristics of these patients and analyzed the development of ribavirin (RBV) treatment failure-associated mutations in the HEV genome. One patient became chronically HEV-infected 110 months after administration of rituximab (RTX). Immunological characterization revealed that all patients exhibited significant hypogammaglobulinemia and CD4+ T cell lymphopenia. One patient permanently cleared HEV following weight-based ribavirin treatment while three patients failed to reach a sustained virological response. In depth mutational analysis confirmed the presence of specific mutations associated with RBV treatment failure in these patients. Our cases indicate that rituximab-containing treatment regimens might imply a relevant risk for persistent HEV infection even years after the last rituximab application. Moreover, we provide further evidence to prior observations suggesting that chronically HEV infected patients following RTX-containing treatment regimens might be difficult to treat.

Suggested Citation

  • Marten Schulz & Paula Biedermann & Claus-Thomas Bock & Jörg Hofmann & Mira Choi & Frank Tacke & Leif Gunnar Hanitsch & Tobias Mueller, 2020. "Rituximab-Containing Treatment Regimens May Imply a Long-Term Risk for Difficult-To-Treat Chronic Hepatitis E," IJERPH, MDPI, vol. 17(1), pages 1-11, January.
  • Handle: RePEc:gam:jijerp:v:17:y:2020:i:1:p:341-:d:304956
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/17/1/341/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/1660-4601/17/1/341/
    Download Restriction: no
    ---><---

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:17:y:2020:i:1:p:341-:d:304956. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.