Emerging Enigmatic Hepatitis E Virus: Molecular Biology, Epidemiology, Diagnosis and Management in Pregnancy

  • Akhlaaq Wazeer Mirpur University of Science & Technology, Mirpur, AJ&K/Div. HQs Teaching Hospital, Mirpur, AJ&K
  • Usman Waheed Peshawar Regional Blood Centre, Department of Health, Khyber Pakhtunkhwa, Pakistan
  • Noore Saba Peshawar Regional Blood Centre, Department of Health, Khyber Pakhtunkhwa, Pakistan
  • Sara Akram Department of Gynae, Divisional Headquarters Teaching Hospital, Mirpur, AJK, Pakistan
  • Bashir Ahmad Department of Biotechnology, International Islamic University, Islamabad, Pakistan
  • Raja Tahir Mahmood Department of Biotechnology, Mirpur University of Science and Technology, Mirpur, AJK, Pakistan


Early in the 1980s, an epidemic of unexplained acute hepatitis was linked to the hepatitis E virus (HEV) which is now the 5th known type of viral hepatitis. The virus is single-stranded RNA that mostly affects developing countries but has lately expanded to developed economies as well. HEV is responsible for large-scale outbreaks of acute viral hepatitis. Acute hepatitis caused by hepatitis E infection has long gone unacknowledged, and its effects on developed countries are likewise misunderstood. In unhygienic settings, HEV is transmitted by the faecal-oral route, as well as through vertical transmission and, on rare occasions, through blood transfusions. HEV genotypes 1-4 are the most prevalent genotypes eliciting infections in humans out of the eight distinct genotypes that have been so far found. Humans are more likely to get HEV1 and HEV2 infections than HEV3 and HEV4, which are zoonotic. HEV infection has a wide range of clinical phenotypes, which makes diagnosis difficult. A variety of other variables also contribute to this difficulty. Serological screening alongside molecular analysis of RNA is used for laboratory diagnosis. Acute HEV infection can resolve on its own and doesn't require any special therapy. However, in certain patients, notably women who are pregnant and those with underlying chronic liver illnesses, acute HEV infection can proceed to chronic hepatitis and liver failure. It has been proposed that the accompanying hormonal changes and ensuing immune alterations during pregnancy are secondary causes of the increased death rate in pregnancy. In this in-depth study, we included the most recent information on the virus itself, epidemiology, diagnosis, pregnancy-related HEV, and treatment options for HEV infection in pregnancy. If we want to comprehend the HEV's natural history, enhance management, and lessen the burden of disease globally, advancements in the detection and diagnosis (serological and molecular) of HEV infection are necessary.

Review Article