Failure to respond to ribavirin despite elevated intra‐erythrocyte zinc level in transplant‐patients with chronic hepatitis E virus infection

Ribavirin was showed to be very effective for treating chronic hep‐atitis E virus (HEV) infection in immunosuppressed patients, especially in solid organ transplant patients in whom it allows to achieve a sustained virological response in nearly 90% of them. However, in few patients, despite a retreatment by ribavirin for a longer period or adding other antiviral drugs such as sofosbuvir, HEV RNA remains detectable. Recently, zinc salt, which is known to reduce infections induced by viruses, was tested in vitro against HEV. It has been shown that it inhibits the activity of viral RNA‐dependent RNA polymerase(RdRp), leading to inhibition of HEV replication.3,4 In addition, it has a synergistic effect with ribavirin on HEV replication. Herein, we report two cases of chronic HEV infection in which we failed to obtain HEV clearance despite normal and increased intra‐erythrocyte zinc levels measured by an atomic absorption spectrophotometer.