Acute HEV infection is clinically silent in the vast majority (up to 95%) of immunocompetent patients, and acute liver failure is unlikely (although it may be missed in some patients as the effectiveness of HEV RNA testing is variable).[71]Manka P, Bechmann LP, Coombes JD, et al. Hepatitis E virus infection as a possible cause of acute liver failure in Europe. Clin Gastroenterol Hepatol. 2015 Oct;13(10):1836-42.e2.
https://www.cghjournal.org/article/S1542-3565(15)00416-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/25912835?tool=bestpractice.com
However, in pregnant women the infection can have serious consequences, with the mortality rate in this group being approximately 25%.[10]Patra S, Kumar A, Trivedi SS, et al. Maternal and fetal outcomes in pregnant women with acute hepatitis E virus infection. Ann Intern Med. 2007 Jul 3;147(1):28-33.
http://www.ncbi.nlm.nih.gov/pubmed/17606958?tool=bestpractice.com
[17]Kamar N, Bendall R, Legrand-Abravanel F, et al. Hepatitis E. Lancet. 2012 Jun 30;379(9835):2477-88.
http://www.ncbi.nlm.nih.gov/pubmed/22549046?tool=bestpractice.com
Malnourished patients and patients with underlying liver disease may be at increased risk of decompensation after acute HEV infection.[11]Kumar Acharya S, Kumar Sharma P, Singh R, et al. Hepatitis E virus (HEV) infection in patients with cirrhosis is associated with rapid decompensation and death. J Hepatol. 2007 Mar;46(3):387-94.
http://www.ncbi.nlm.nih.gov/pubmed/17125878?tool=bestpractice.com
A prolonged cholestatic hepatitis can occur with acute HEV but typically resolves fully.[12]Hoofnagle JH, Nelson KE, Purcell RH. Hepatitis E. N Engl J Med. 2012 Sep 27;367(13):1237-44.
http://www.ncbi.nlm.nih.gov/pubmed/23013075?tool=bestpractice.com
Chronic HEV infection develops almost exclusively in immunosuppressed patients and can progress to cirrhosis if treatment is unsuccessful.[38]Péron JM. Hepatitis E virus infection and cirrhosis of the liver. Gastroenterol Hepatol (N Y). 2016 Sep;12(9):565-7.
https://www.gastroenterologyandhepatology.net/archives/september-2016/hepatitis-e-virus-infection-and-cirrhosis-of-the-liver
http://www.ncbi.nlm.nih.gov/pubmed/27917096?tool=bestpractice.com
[72]Schlosser B, Stein A, Neuhaus R, et al. Liver transplant from a donor with occult HEV infection induced chronic hepatitis and cirrhosis in the recipient. J Hepatol. 2012 Feb;56(2):500-2.
https://www.journal-of-hepatology.eu/article/S0168-8278(11)00564-2/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/21798217?tool=bestpractice.com
A solid organ transplant recipient infected with HEV has between 50% and 70% risk of developing chronic HEV infection, which can progress to cirrhosis within several years.[38]Péron JM. Hepatitis E virus infection and cirrhosis of the liver. Gastroenterol Hepatol (N Y). 2016 Sep;12(9):565-7.
https://www.gastroenterologyandhepatology.net/archives/september-2016/hepatitis-e-virus-infection-and-cirrhosis-of-the-liver
http://www.ncbi.nlm.nih.gov/pubmed/27917096?tool=bestpractice.com
[49]Pischke S, Stiefel P, Franz B, et al. Chronic hepatitis E in heart transplant recipients. Am J Transplant. 2012 Nov;12(11):3128-33.
https://www.amjtransplant.org/article/S1600-6135(22)27702-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/22823202?tool=bestpractice.com
See Complications.