Hepatitis E

If the patient has symptomatic acute HEV infection, monitor to identify change in clinical status that indicates potentially severe disease (i.e., may require transplantation), particularly in pregnant women.

• Intermittent monitoring of liver enzymes and liver function tests is sufficient in patients with acute HEV who are not taking antiviral therapy.

• Monitor coagulation parameters if the clinical picture, particularly liver function, worsens significantly.

If the patient has chronic HEV and is on antiviral therapy, the aim of monitoring is to evaluate treatment response and adverse effects.

Patients on ribavirin should be monitored with full blood count, chemistry panel, and HEV RNA (serum and stool) periodically (every 4 weeks or more frequently if there are serological indications of treatment-related adverse effects such as drop in haemoglobin/deterioration of renal function).[25]British Transplantation Society. Guidelines for hepatitis E and solid organ transplantation. ​First edition. Apr 2017 [internet publication]. https://bts.org.uk/wp-content/uploads/2017/06/BTS_HEV_Guideline-FINAL.pdf

Stop ribavirin if both serum and stool HEV RNA are negative as this indicates a sustained viral response; note that stool HEV RNA may remain positive long after serum HEV RNA is negative, hence the requirement for stool HEV testing to avoid relapse.