Background: To date, there is no established therapy for hepatitis-E-virus (HEV) infection. The aims of this retrospective multicenter study were to assess the efficacy and safety of ribavirin as a monotherapy for solid-organ-transplant (SOT) patients with chronic HEV infection.

Patients: 51 SOT patients (30 kidney-, 9 liver-, 5 heart-, 5 kidney-pancreas-, and 2 lung-transplant patients) were included in this study. Ribavirin therapy was initiated 11 (1-82) months after HEV diagnosis at the median dose of 600 (29–1200) mg/d, i.e., 8.9 (0.6–16.3) mg/kg/d, and was given for 3 (1-18) months (69% of patients received ribavirin for £3 months).

Results: All patients were viremic when ribavirin was initiated. At the end of therapy, all patients but one were cleared of the virus (98%). A relapse of HEV replication was observed in eight patients after ribavirin cessation. A sustained virological response (SVR), i.e., negative HEV RNA serum for at least 6 months after ribavirin cessation, occurred in 42 of the 51 patients (82.4%). A SVR was also observed in three relapsers who were retreated for a longer period. A higher lymphocyte count at the initiation of ribavirin therapy was the sole predictive factor for SVR. Anemia was the main side-effect. It required ribavirin dose reduction, erythropoietin use, and blood transfusions in, respectively, 29%, 57%, and 10% of patients.

Conclusion: This retrospective multicenter study shows that ribavirin as a monotherapy is highly efficient at treating chronic HEV infection. A 3-month course seems to be the optimal duration for this therapy.

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