Hepatitis E virus infections in immunocompromised patients

Hepatitis E virus (HEV) is an important cause of viral hepatitis globally. Historically considered an acute and self-limiting illness, HEV has emerged as a significant pathogen in various immunocompromised patient groups in the last 15 years. Vulnerable patients include transplant recipients, people living with advanced HIV infection, and patients with hematological malignancies, rheumatological disorders, or autoimmune diseases. These individuals are vulnerable to chronic hepatitis and extrahepatic manifestations due to HEV. These risks are also relevant to emerging modalities of immunosuppression such as new targeted drug therapies and chimeric antigen receptor T-cell therapies. Besides unique clinical implications, immunocompromised hosts have also been at the center of new developments in the hepatitis E field on zoonotic reservoirs, transmission routes, disease models, and pathogenesis. In this review, we present a comprehensive integrative summary of the epidemiology, clinical manifestations, pathogenesis, diagnosis, and management strategies of HEV infections in immunocompromised hosts.