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Leading experts in the HEV provided a comprehensive overview of our current knowledge of HEV and the prospects for future treatments.

The challenges in the management of HEV, one of the most common causes of acute hepatitis and jaundice worldwide, remain acute. Gaps in our knowledge remain regarding the molecular virology, pathogenesis, epidemiology and transmission of HEV, while researchers are still seeking standardized diagnostics, improved therapies and a better understanding of the viral and host determinants of clinical outcomes. In an engaging interactive session, leading experts in the field provided a comprehensive overview of our current knowledge of HEV and the prospects for future treatments.

While many people with HEV are asymptomatic or have only mild hepatitis, the seriousness of this infection was underscored by data presented from multiple countries showing significant minorities of experiencing severe or life-threatening manifestations: approximately 6% experience acute-on-chronic liver failure (ACLF), 5% experience neurological complications, and a 7% HEV-related mortality was reported in a recent French cohort. Attendees were brought up to date on the pathogenesis of HEV, with four key mechanisms underlying many of its diverse manifestations: an inappropriate immune response in acute liver failure, ACLF or neurological injury; extrahepatic replication in neurological injury, acute kidney injury pregnancy complications; chronic immune stimulation in cryoglobulinaemia, acute liver injury and lymphoma; and immunodeficiency in chronic of HEV infection and subsequent cirrhosis and liver cancer.

Primary prevention of HEV infection remains a challenge, and data was presented showing the extent to which the virus is resistant to alcohol and many disinfectants. However, in terms of treatment, new host and viral therapeutic targets were described that could for the basis for potential treatment strategies. Although to date only pegIFN and ribavirin are recommended in EASL guidelines, testing and validation of combination and sequential treatment approaches with ribavirin, sofosbuvir and silvestrol may expand treatment option.