Effective treatment of acute hepatitis E by ribavirin in a patient complicated with renal impairment: a case report

Abstract

Background: Hepatitis E infections are the most common cause of acute viral hepatitis worldwide. High-risk patients such as the immunocompromised or those with a background of liver disease co-infected with hepatitis E virus (HEV) have particularly high morbidity and mortality rates. Currently, there are no approved treatments for acute infections. Although ribavirin is proposed as a viable option, dosing in renally impaired patients is not well established. Aim: To present a case describing ribavirin use in the treatment of acute hepatitis E infection, complicated by acute kidney injury. Clinical details: A 56-year-old man presented to hospital with severely deranged liver function tests and jaundice. Serology tests confirmed diagnoses of acute hepatitis E and ribavirin was commenced. Acute renal impairment developed and ribavirin was reduced to 200 mg p.o. in the morning and 400 mg p.o. at night for a total of four weeks. A total of 12 weeks’ therapy was completed. Outcomes: Liver function tests (LFTs) showed drastic and significant improvement within one week of commencing ribavirin. Levels largely normalised by four weeks of therapy. No adverse events were reported throughout ribavirin therapy and HEV reactivation was not observed. Conclusion: Ribavirin may be an effective and safe treatment for acute hepatitis E infections with concurrent acute kidney impairment. In this case, adjusting ribavirin doses to renal function led to a good clinical outcome, as highlighted by the normalisation of LFTs. Further studies are required to establish an appropriate ribavirin dosing regimen among patients with HEV, particularly in the context of renal impairment.