Screening, diagnosis and risks associated with Hepatitis E virus infection.

Introduction: Hepatitis E virus (HEV) is the main cause of hepatitis worldwide. Our knowledge of this single-strand positive-sense RNA virus, discovered in the 1980s, has improved greatly in recent years. Areas covered: We review the most recent information on diagnostic tools, including serological and molecular assays, the recommended diagnostic algorithm, and the clinical manifestations of HEV infections. Expert opinion: The performance of serological and molecular assays has improved greatly in recent years and the availability of a WHO standard has been invaluable for comparing the performance of molecular assays. The more efficient serological and molecular assays have led to a clearer picture of HEV epidemiology. It is now established that HEV is distributed worldwide. The European Association for the Study of the Liver (EASL) now recommends testing for anti-HEV IgM and HEV RNA. Molecular tests indicate that HEV RNA is very common in asymptomatic blood donors. The description of transfusion-transmitted HEV makes having optimal strategies essential for improving blood safety. Like other hepatitis viruses, HEV infection must be suspected whenever a patient presents with clinical or biochemical features of hepatitis. An HEV infection can also have extra-hepatic manifestations, especially neurological and renal disorders.