It is very rare for someone with a normal immune system to develop severe liver damage because of hepatitis E.
If this does happen, you might need to be treated with a medicine called Ribavirin. But because severe hepatitis E is so rare every case is different.
Ribavarin can have serious side effects, so it is important to talk to your consultant about the risks and benefits of treatment for you.
If you do not get better from hepatitis E in 3 to 6 months then your condition will be called chronic hepatitis E.
Chronic hepatitis E is very rare. It usually affects people who are immunosuppressed because of medicines they take. In particular, people who have recently had a transplant.
It is important to get treatment for chronic hepatitis E to prevent long-term damage to your liver.
Treatment for chronic hepatitis E for people who have had a liver transplant
The first step in treating chronic hepatitis E is to reduce your immunosuppressant medicines. This allows your own immune system to fight off the virus.
Reducing immunosuppression works for about 3 in 10 people with chronic hepatitis E.
But your medicines are very important. You must talk to your doctor before making any changes to them. And you will need to be carefully monitored.
It might not be safe for you to reduce your medicine. Or you might have tried this and still have hepatitis E. In this case doctors might suggest using an antiviral medicine called Ribavirin.
Ribavirin is an antiviral drug. It can help your body to get rid of the virus. You will usually take it for 3 months.
It can have a lot of side effects. Some of these can be quite serious. Especially if you also have problems with your kidneys. So you will need to be closely monitored. And you might have the amount of Ribavirin (the dose) adjusted.
If you still have hepatitis E after 3 months, you might need to have Ribavirin for another 6 months.
If Ribavirin on its own has not worked, you might be offered a medicine called interferon. The full name is pegylated-interferon alpha. It is given by injection. If you need to have interferon you will be given pre-filled syringes and a doctor or nurse will show you how to do the injections.
Not everyone can have interferon. It can also have strong side effects so you will have regular check-ups.
Treatment for chronic hepatitis E for people who are immunosuppressed for other reasons.
Because chronic hepatitis E is very rare, there is not an established method of treatment for people in other groups.
If you have had a different type of transplant you will have the treatment described above. But you may not be able to have pegylated interferon treatment. Especially if you have had a kidney transplant.
In other cases, doctors should discuss your treatment options with you. These will be very individual and based on your health, medical conditions, and other treatments.
Published: November 2023
Review due: November 2026