Prognosis

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]

However, in pregnant women the infection can have serious consequences, with the mortality rate in this group being approximately 25%.​[10][17]​​ Malnourished patients and patients with underlying liver disease may be at increased risk of decompensation after acute HEV infection.[11]​ A prolonged cholestatic hepatitis can occur with acute HEV but typically resolves fully.[12]

Chronic HEV infection develops almost exclusively in immunosuppressed patients and can progress to cirrhosis if treatment is unsuccessful.[38][72]​​​​ 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][49]​ See Complications.

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