Background: With the postulation that ribavirin, an antiviral agent, can modulate the clinical course of severe acute hepatitis due to hepatitis E virus (HEV), a clinical trial was conducted in patients with acute hepatitis E. Materials and methods: A total of 24 patients with severe acute hepatitis E were enrolled in this study. Ribavirin was given at a dose of 400 mg, twice a day for 28 days. The clinical course of the disease was assessed on a regular basis. Results: Out of 24 patients in this cohort, three patients were lost during follow-up and their prognosis remains unknown. A total of six patients died during follow-up. The rest 15 patients showed improvement of their pathological conditions during observation period. Conclusion: Although preliminary, this study indicates that more information is required about beneficial and detrimental effects of ribavirin in patients with severe acute hepatitis E. This study inspired optimism that a randomized-controlled trial of ribavirin should be adopted in severe acute hepatitis E to develop proper in sights in this regard.