Chronic hepatitis E in HIV/HBV coinfected patient: lack of power of sofosbuvir–ribavirin

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Hepatitis E virus (HEV) infection is an emerging zoonotic infection in developed countries. Data suggest that HEV is endemic in France [1]. In addition to hepatitis, HEV has been associated with neurological impairments particularly Guillain-Barré syndrome, neuralgic amyotrophy, and encephalitis [2]. Chronically persisting viremia is a rare event mainly restricted to profound immunosuppression, including HIV-infected patients with a CD4+ cell count below 200/μl, with a risk of cirrhosis within less than 3 years [3]. Recently, sofosbuvir was shown to inhibit HEV genotype 3 replication in vitro (inhibitory concentration 50% = 635 ng/ml, versus 7–58 ng/ml for HCV), with an additive effect with ribavirin [4]. We report the failure of sofosbuvir/ribavirin to treat a chronic HEV infection in an HIV/HBV coinfected patient with severe immunosuppression.

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